Facet arthropathy is a common condition that is a type of arthritis. Facet arthropathy occurs when the facet joints of the back degenerate or become worn down, and the protective cushion between the facet joints, made up of cartilage and fluid, become thinner or damaged through wear and tear. Facet joints are joints located between the bony projections at the back of the vertebrae.
Just as with knees, hips, or other joints in the body, without sufficient fluid and cartilage, bones in the facet joint may rub together or not move as freely. The result can be pain, swelling, and stiffness.
Risk Factors of Facet Arthropathy
Facet arthropathy is a degenerative, arthritic condition. As with arthritis that occurs in joints elsewhere in the body, facet arthropathy occurs most often in older adults, and results from wear and tear.
Facet arthropathy is slightly more common in women than in men. Being overweight or obese also increases the risk of developing facet arthropathy.
Less common risk factors include:
- Trauma — such as a vehicle crash, sports injury, or fall — which causes damage to a facet joint that can lead to facet arthropathy
- Heavy lifting or improper posture over long periods
Common Symptoms of Facet Arthropathy
Often, patients can have facet arthropathy for some time without being aware of the condition. When symptoms do occur, they typically include:
- Lower back pain that is a dull ache
- Pain that becomes worse when twisting, standing, or bending backward
- Stiffness in the neck or back
- Unlike lower back pain caused by other conditions, facet arthropathy pain typically does not radiate down the legs
Many people who have facet arthropathy have additional conditions that contribute to symptoms. As the facet joints become arthritic, they may develop tiny outgrowths or projections of bone, called bone spurs, that can decrease the amount of space available for the nerve roots as they exit the spinal canal. This, in turn, can contribute to the development of spinal stenosis and subsequent leg symptoms.
Non-surgical Treatment for Facet Arthropathy
At Neurosurgery One (formerly South Denver Neurosurgery), facet arthropathy typically is treated first with non-invasive therapies including:
- Steroid injections. A steroid injection can provide temporary pain relief.
- Physical therapy. Your physician may suggest physical therapy, possibly along with pain-relieving steroid injections so that exercises can be done with minimal discomfort.
- Pain medications. Over-the-counter pain relievers, such as acetaminophen (Tylenol), and non-steroidal anti-inflammatory medicines such as ibuprofen or aspirin may be useful for chronic pain. Prescription pain relievers may be necessary during episodes of extreme pain but are not recommended for long-term relief.
- Nerve blocks. First, a diagnostic nerve block test is performed to confirm the source of pain. Anesthetic is injected along the nerve to “block” pain. If the block is successful, a radiofrequency ablation can often provide pain relief that lasts several months to a year.
- Nerve ablations. In this procedure, an electrode is inserted through the skin and a radiofrequency current destroys some of the nerve fibers carrying pain signals in the joint.
Surgery to Relieve Pain from Facet Arthropathy
At Neurosurgery One, our Denver spine neurosurgeons are very conservative and will recommend surgery for degenerative disc disease only for patients experiencing severe pain that is not relieved by non-surgical treatments. Some cases that involve nerve root compression from enlarged facet joints, degenerative disc disease, or spinal instability may have to resort to surgery.
For patients whose pain from facet arthropathy is not relieved with non-invasive treatment, spinal fusion surgery may be recommended.
Spinal fusion surgery is designed to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint. Learn more about spinal fusion surgery.