At every level of the spine, the vertebral bones are typically spaced apart by a “cushion” called the vertebral disc. This disc resides in the front part of the bony spinal column. Along the back part, where the bones come together, there is a contact point at each level on the left and right side. This contact point where the bones come together creates a joint on each side called the facet joint. This facet joint has cartilage lining the joint and a capsule surrounding the joint, just like any other joint in your body. The purpose of this facet joint is to provide stability and mobility to the spine, especially on bending, extending and rotation of the spine.
Similar to other joints in the body, this joint is susceptible to inflammation and degeneration, a condition referred to as facet arthritis or facet joint disease. It can occur in the upper (cervical), middle (thoracic) and lower (lumbar) portions of the spine.
The primary presenting symptom for cervical facet arthritis is typically neck pain. The pain can either be on one side or both. This neck pain can radiate to the back of the head, behind the ear, into the scapula, the trapezius, shoulder, and sometimes even the upper arm. Pain from cervical facet arthritis does not typically radiate down the entire arm unless the overgrowth (hypertrophy) of the facet joint from arthritis begins to irritate adjacent nerves. Pain quality can vary from constant dull aching to sharp stabbing pain depending on the amount of arthritis and inflammation. The pain is typically worsened by movement of the neck, usually to the side, up, or both.
Inflamed thoracic facet joints typically cause mid-back pain. It can occur on one side or both. It may spread across the back and may also radiate into the chest or upper abdomen. Pain can vary from a constant dull aching to sharp, stabbing pain depending on the amount of arthritis and inflammation. Pain is often worse with extension and rotation of the spine.
Inflamed lumbar facet joints typically cause low-back pain. It can present on one side or both. It may spread across the back and may radiate to the back of the legs (usually stopping at the knees). Pain from lumbar facet arthritis does not typically radiate down the entire leg unless the overgrowth (hypertrophy) of the facet joint from arthritis begins to irritate adjacent nerves. Pain quality can vary from constant dull aching to sharp stabbing pain, depending on the amount of arthritis and inflammation. Pain is often worse with extension and rotation of the spine.
Degeneration of the intervertebral disc, a common occurrence as we age, usually also leads to degeneration of the facet joints. Eventual degeneration of the disc causes abnormal and increased pressure on the cartilage lining of the joints. This pressure can lead to wearing down of the cartilage to the point where the cartilage deteriorates and disappears, causing bone-on-bone stress and inflammation. If this bone-on-bone stress continues, the bones can overgrow (hypertrophy), and bone spurs can develop.
Sometimes the joint capsule itself can be damaged and become inflamed. This can occur with whiplash injuries such as a car accident. In these situations, it is possible the imaging study will not show significant arthritis of a facet joint despite the joint being a generator of pain.
Your Center for Pain Management physician will work with you to determine the best treatment plan for your unique case. Possible treatments range from non-invasive therapy such as physical therapy and medication to minimally invasive options. Typically these options would first focus on determining which facet joints are responsible for your pain.
A minimally invasive procedure under accurate x-ray guidance can be used to accurately find the generator of pain. This can be done by either temporarily anesthetizing the small nerves providing sensation to the joint (medial branch nerve block) or by injecting the joint itself with cortisone and numbing medicine (facet joint injection).
Once the joints causing the pain are firmly established, a procedure called radiofrequency denervation can be used to permanently deaden or stun the nerves and minimize the ability of the facet joint to send pain signals while still allowing the facet joint full range of motion and function.