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Cervical Facet Joint Degeneration

What are the Cervical Facet Joints?

The are the joints located on the back of our spines opposite the disc, which is located in the front of the spine between the bodies of the vertebrae. The facet joints are made up by bone pieces (articular processes) from the vertebrae next to each other. Each vertebra contributes one articular process to the joint.

The facet joint itself has cartilage like many other joints in the body. Each joint is surrounded by a tough capsule which strengthens the joint.

What function do Cervical Facet Joints have?

The facet joints move like windshield wipers when looking at them from the side. Flexion (forward motion) and extension (backward motion) are the primary motion of the facet joints. They also prevent the spine from slipping sideways in the horizontal plane (shearing).

What causes Facet Joint Degeneration?

Facet joint degeneration is a common problem and is expected to some degree as our spine ages. A contributing factor to this is the thinning of the as we age. The loss of the height of the disc will place more weight onto the facet joints, which begin to show signs of stress. Ordinarily, the facet joints carry 20% of the body’s weight. However with loss if the disc’s height and function, up to 50% of the body’s weight may have to be carried by these joints. Over time, these joints will lose their cartilage and the joint space narrows. Eventually, the joins enlarge as the two bones which make up the joint () begin to make contact. As these articular processes rub against each other, they form new bone, resulting in spurring and enlargement of the joint.

What spine levels are most commonly affected by Facet Joint Degeneration?

Facet joint degeneration is most commonly present in the same spinal segments most affected by degenerative disc disease, namely C5/6, and C6/7 in the neck.

What are the common symptoms of Cervical Facet Joint Degeneration?

Patients with facet pain will often suffer from pain on the side of the spine (paraspinal).

Facet related spine pain is often worse when the spine is bent backwards. This is called “facet loading” as more weight is distributed to the facet joint and away from the disc. Contrary to that, patients with disc related pain typically feel worse when bending forward. Facet pain is also often located in a smaller more defined area, whereas disc related pain can spread more. Here are some of the symptoms:

  1. Neck pain
  2. Neck stiffness
  3. Muscle spasms
  4. Pain radiating to the shoulders and arm
  5. Worsening pain when looking up

How is Cervical Facet Joint Degeneration diagnosed?

Spine specialists use information from the patient history, physical examination and special spinal tests to make this diagnosis:

  1. History

Patients often complain of pain following periods of rest, once they resume an activity. Typically patients do not have a history of a specific neck injury, but rather smaller more repetitive ones. Patients often feel the symptoms from facet pain come on slowly over time. Activities which require looking up for longer periods of time are commonly painful. Spine specialists will often try to separate symptoms of disc disease from those of facet disease when they obtain the patient’s history.

       2. Physical Exam

On the exam, the pain is usually well localized and has a common pattern to it. The patient is frequently asked to bend backwards and sideways. Pain in that position points to the facet joint. Here are some examination points:

  1. Palpation (touch and pressure) of the spine
  2. Range of motion (mobility) testing
  3. Flexion and extension maneuvers (forward and backward bending)
  4. Facet Loading Maneuver
  5. Sensation testing
  6. Strength (motor) testing
  7. Reflex testing

 

       3. Imaging

A. X-Rays

X-Rays can show facet disease if the joint is enlarged and the joint space narrowed. Some facet joints can appear relatively normal on an X-Ray and yet be the source of the patient’s spine pain.

B. MRI Scans

MRI technology is best used for softer structures rather than bone anatomy. However, MRI images can show facet joints quite well. It can also be useful to evaluate the disc at the same time to see if more than one possible disease process is present. Bone spurs and cysts of the facet joint can be seen.

C. CT-Scan

CT technology can show facet joints with the most detail. However, in the case of severe facet spurs, the impact of these spurs on the or cannot be easily seen. The high dose of radiation of CT scans versus no radiation with an MRI, often makes the physician chose a MRI over a CT scan for the purposes of evaluating facet joints.

D. Nuclear Bone Scans

Bone scans are excellent at showing severe inflammation of the facet joints. However this study is only useful to evaluate bone. It cannot show the other structures of the spine such as discs and spinal nerves.

E. Diagnostic Cervical Facet Injection

For diagnostic reasons, sometimes the facet joint is anesthetized with a local anesthetic and the patient’s response to the injected evaluated. This can be done very soon after the injection while theis still active and the joint is “numb”. The injection is done with the help of an X-Ray machine to see the joints.

F. Cervical Medial Branch Block

A medial branch block is an injection done with local anesthetics to block the nerves traveling to the facet joint. The patient is then evaluated to see if the pain has improved or is eliminated.

How is Cervical Facet Joint Degeneration treated?

For the chronic pain from Cervical Facet Degeneration, non-surgical and surgical interventions are available. Here are some of them:

 

  1. Non-Surgical Treatments

A. Alternative Health Care

There are some alternative health interventions which can add to conventional medical care. techniques can help with the muscle component from cervical facet joint disease. techniques can relieve muscle pain related to Facet disease. exercises, and can help with pain as well.

B. Chiropractic Care

Chiropractic spine manipulation can help with the symptoms from cervical facet joint disease by restoring normal alignment and motion.

C. Spine Exercises

Specific spine exercises can help regain and maintain the mobility in the neck, which is often lost from guarding against pain.

D. Physical Therapy (PT)

PT may focus on improving posture and maintaining normal muscle function amongst others. Ultrasound and muscle stimulation techniques can help with painful neck spasms. Neck traction may also be helpful.

E. Self Help Devices

Self Help Devices such as Neck Braces, Neck Pillows, Back Mattresses and Home Traction Devices can help with the pain from Facet Joint Degeneration in the Neck.

F. Medications

Here are some medication options for chronic pain from Facet Joint Degeneration:

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

Muscle relaxants

Pain Killers

G. Injections

Here are some injections which can help with the pain from degenerated Facet Joints in the Neck:

  1. Cervical Facet Joint Injections

Facet injections both for diagnosis and treatment are often helpful.

      2. Cervical Medical Branch Block

Blocking the Nerve traveling to the Facet Joint can help verify that these joints are indeed the source of pain.

      3. Radiofrequency Rhizotomy

For longer term relief, Radiofrequency Rhizotomies are often attempted. They are minimally invasive procedures with short recovery times.

 

     2. Surgical Treatments

Surgery for facet joint degeneration by itself is uncommon and is reserved for patients who have failed non-surgical care and are experiencing severe symptoms. More often patients who undergo surgery suffer from a combination of issues, some related to degenerative disc disease, and some to the facet joint degeneration.

Spinal stenosis caused by the enlargement and bone spurring of the facet joint is another reason for surgery.

 

Here are some possible surgical treatments:

  1. Anterior Cervical Decompression and Fusion (ADCF)
  2. Posterior Cervical Fusion