Facet Joint Arthritis
Apart from the small hyoid bone in your neck, every other bone in your body meets another bone at a joint.
Some joints don’t allow any movement at all, such as the joints in your skull.
Other joints, like your knees or shoulders, allow a lot of movement – that’s their whole purpose, after all.
These are known as synovial joints. The ends of the meeting bones are covered by shock-absorbing cartilage to reduce friction while the space between and around the bone ends is filled with synovial fluid that nourishes and lubricates the cartilage.
What are facet joints?
Your spine is made up of 26 body building blocks known as vertebrae with a spongy, shock-absorbing disc between each one. Each vertebrae has its own pair of facet joints at the back that connect it to the next vertebrae. These facet joints allow you to bend, twist and stretch your spine while restricting excessive movement.
Like other synovial joints, your facet joints include a smooth glistening articular cartilage which caps the bones, a capsule of fibrous tissue that contains the joint and an inner membrane that makes synovial fluid to lubricate the joint.
What is facet joint arthritis?
Facet joints are therefore prone to the same conditions that affect the other synovial joints.
Like your knees, hips and finger joints, facet joints can develop arthritis, particularly:
- Osteoarthritis, caused by age-related degeneration, also known as wear and tear – this is the most common form of spinal arthritis.
- Rheumatoid arthritis, caused by inflammation in the synovium of joints.
- Crystal arthropathy, gout or pseudogout crystals can deposit in the joint and cause inflammation, swelling and pain
- Septic arthritis, a special form of arthritis caused by bacterial infection
Facet joint arthritis may also be known as spinal osteoarthritis, facet joint syndrome and facet disease.
What causes facet joint arthritis?
Your facet joints might be small but they do a big job, particularly in your lower spine where they’re supporting 20% of the weight of your upper body. Like other weight-bearing joints such as your hips and knees, your facet joints seem to show signs of wear and tear earlier than other joints. The cartilage between the joints slowly breaks down, causing inflammation and pain.
A previous injury can cause joint damage that eventually leads to spinal osteoarthritis. Obesity is another contributing factor because it places more strain on your joints while a family history of osteoarthritis increases your risk of developing facet joint arthritis. Facet joint arthritis can also be a knock-on effect of another condition called degenerative disc disease. The spongy discs in between each vertebrae also degenerate with age, becoming flatter and less hydrated. That may contribute to facet joint arthritis by transferring pressure from the disc to the facet joint, triggering more laod and cartilage damage.
What are the symptoms of facet joint arthritis?
You may not experience any symptoms of facet joint arthritis. When we do imaging scans of older people’s spines for other reasons, we commonly also find signs of facet joint arthritis, even though the patient hasn’t shown signs of a problem.
Some people with facet joint arthritis do experience back pain and stiffness, which seems to be worse when the spine is extended (e.g. bending backwards) because that increases the load on the facet joints. Bending forward often eases the pain.
Facet joint arthritis symptoms may also be worse after long periods of inactivity (how do you feel when you wake up in the morning?) or after standing or sitting. Lying down may help relieve the pain.
Facet joint arthritis can contribute to a narrowing of the spinal canal in the middle of each vertebrae, putting pressure on the nerves that pass through this shrinking space. Depending on which spinal level is affected, you might notice symptoms such as:
- Numbness and weakness in your limbs
- Balance and coordination difficulties
- Shooting Pain, burning and tingling in your arms or legs.
Facet joint arthritis is a progressive disease, meaning symptoms tend to get worse as time goes on.
While facet joint arthritis can cause some pain and stiffness, it might not be responsible for all the back pain you feel. Often it’s a contributory cause of back pain but not the whole story.
How is facet joint arthritis diagnosed?
To reach a facet joint arthritis diagnosis, your doctor may:
- Ask about your family history
- Ask about symptoms like back pain, numbness or weakness
- Examine you to check for tenderness, limited range of motion or swelling in your back
- Order imaging tests like an X-ray, CT or MRI to see if there are signs of bone spurs, bone damage or cartilage loss in your facet joints
- Sometimes a Nuclear Medicine bone scan or SPECT may help to isolate which facet joint is most arthritic and help target treatment
- Take a blood test to rule out other conditions that can cause similar symptoms
- Test the fluid in your joints to see if your symptoms are caused by facet joint arthritis, gout or an infection.
How do you treat facet joint arthritis?
Since facet joint arthritis tends to worsen over time, it’s important to get the right treatment to manage the condition.
Facet joint arthritis treatment aims to reduce the load on the affected joint(s) through exercises to strengthen supporting muscles to help share the load. Your doctor or physio may recommend core muscle strengthening and control exercises.
Pain management is also important. Your doctor may try to alleviate your pain using facet joint blocks or cortisone injections. These can provide relief for a few weeks to a few months but you’ll get the best results if you’re diligent about doing your exercises too. More recently radiofrequency denervation of the facet joints has been used to reduce facet joint pain and for some people, they seem to help for a few months to a year or so.
Most people don’t need surgery for facet joint arthritis. Sometimes, though, your arthritis symptoms may be complicated by spinal stenosis or spondylolisthesis. If you have one of those conditions and severe symptoms, then surgery may be the most appropriate treatment.
How can The Victorian Orthopaedic Spine Service help?
If you’re dealing with back pain, stiffness, weakness or numbness then it’s important to get the right diagnosis and treatment. Once we’ve diagnosed your condition, we’re able to advise you on the most appropriate treatment to help relieve your symptoms.
Our care pathway is carefully designed to ensure you only progress to surgery if you really need it and we prefer to try conservative treatments first.
Please make an appointment (you’ll need a referral from your GP first).
Disclaimer
All information is general in nature. Patients should consider their own personal circumstances and seek a second opinion. Any surgical or invasive procedure carries risks.
