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Lumbar Facet Joint Disease

What are the Lumbar Facet Joints?

Our Facet Joints are the joints located on the back of our spine 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 do Lumbar Facet Joint do?

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 Lumbar 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 disc 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 (articular processes) begin to make contact. As these articular processes rub against each other, they form new bone, resulting in spurring and enlargement of the joint. In addition, facet joint cysts can form.

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

Facet joint degeneration is most commonly present in the same spinal segments most affected by degenerative disc disease, namely the L4/5 and L5/S1 levels in the low-back.

What are the common symptoms of Lumbar Facet Joint Degeneration?

Patients with facet pain will often suffer from pain next to the middle 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. Low-back pain
  2. Low-back stiffness
  3. Low-back muscle spasms
  4. Pain radiating to the hips and buttocks
  5. Worsening pain when looking up

How is Lumbar 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 back pain following periods of rest once they resume an activity. Typically patients do not have a history of a specific low-back injury. Patients often feel the symptoms from facet pain come on slowly over time. Spine specialists will try to divide symptoms of disc disease from facet disease while collecting the patient’s history of low-back pain.

      2. Physical Exam

On the exam, the pain is usually well localized and has a common pattern to it. The patient is often 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 in the legs
  6. Strength (motor) testing in the legs
  7. Reflex testing in the legs

 

      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 spinal cord or spinal nerves 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 Lumbar 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 the anesthetic is still active.

The injection is done with the help of an X-Ray machine to see the joints.

F. Lumbar 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 Lumbar Facet Joint Degeneration treated?

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

 

  1. Non-Surgical

A. Alternative Health Care

Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition. Massage Therapy techniques can help with the muscle component from lumbar facet joint disease.

B. Nutrition and Weight Loss

Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms (Spine and Obesity).

C. Chiropractic Care

Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition.

D. Spine Exercises

Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility.

E. Physical Therapy (PT)

PT has many modalities to offer for this condition. They can range from Manual Therapy and Exercises to Traction and Ultrasound Treatments. PT may focus on improving posture, exercising spinal muscles, and providing core strength amongst others. Ultrasound and muscle stimulation techniques can help with painful back spasms. Back traction may also be helpful.

F. Self Help Tools

Self Help Tools are items which can be purchased to help with back pain. They range from Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories.

G. Spine Medications

Here are some of the common groups of medications which are available for this condition:

  1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
  2. Muscle relaxants
  3. Nerve Pain Medications
  4. Pain Killers
  5. Antidepressants
  6. Topical Medications

H.Spine Injections

  1. Lumbar Facet Joint Injections. Facet injections can be very useful both as a tool for diagnosis as well as a treatment option.
  2. Lumbar Medial Branch Block
  3. Lumbar Facet Joint Radiofrequency Rhizotomy. For longer term relief, often Radiofrequency Rhizotomies are attempted. These are minimally invasive procedures with short recovery times.

 

 

      2. Surgical Care

Treating pain from facet joint degeneration with surgery is relatively uncommon, and reserved for patients who have failed non-surgical care and are having severe symptoms. These patients will often suffer from a combination of issues, some related to degenerative disc disease, and some to the facet joint degeneration. Also, spinal stenosis caused by the enlargement and bone spurring of the facet joint is often a reason for surgery.

Here are some possible surgical treatments:

  1. Endoscopic Lumbar Spine Surgery
  2. Lumbar Dynamic Stabilization
  3. Lumbar Laminotomy and Foraminotomy
  4. Lumbar Laminectomy Decompression (for spinal stenosis caused by the facet joints)
  5. Lumbar Fusion