Facet Treatments

A facet treatment is a pharmacological therapy that is used to treat the pain and physical dysfunction caused by facet arthritis. Facet arthritis is the degeneration of the cartilage joint that hold the facets together at the back of the spine. In the human spine, the vertebra are linked together in the front of the spine by the intervertebral discs, and the back of the spine at the facet joints, where each pain of inferior articular processes of the vertebra above are in contact with the superior articular processes of the vertebra below. At each facet joint, there is a band of cartilage that is located between the two linking facets to prevent against friction as the two facets glide and move against one another. Facet arthritis may occur as this layer of cartilage wears out due to the aging process, infection, or due to the loosening of these spinal ligaments. The degeneration of this facet cartilage may be accelerated by and anatomical changes to the spine that cause the facet joints to become weight bearing structures. The facet joints are not designed to be weight-bearing structures.

Together each pair of vertebral bones forms a three joint complex known as a motion segment. This three joint complex includes the intervertebral disc as well as the pair of facet joints.

Each vertebra has several processes that project from the vertebral arch, a ring of bones that is fused to the back of the vertebral body. Each vertebra has two superior processes that project upwards and two inferior processes that project upwards to link the vertebrae together. The ends of each process have a smooth face where they will come into near contact with the adjoining facets above and below. The facet joint consists of the two ends of the processes with cartilage between them and a fluid filled capsule to hold the joint complex together.

Together the cartilage and capsule allow for both the movement of the facet joint and protection against friction and forces that would separate the structure. Due to a variety of possible medical conditions, including spinal injury, infection, disease, and wear and tear, the cartilage between the two opposing bony surfaces becomes eroded, resulting in friction between the bony surfaces. This friction may cause inflammation and pain. The inflammation and damage to the ends of the bony processes may result in stiffness and diminished mobility in that part of the back.

Facet treatment involves therapy to decrease inflammation and stiffness of these facet joint structures and a back exercise program to compensate for the instability of the spine caused by facet arthritis.

Symptoms of osteoarthritis of the facet joints: Lower back pain that is caused by facet arthritis is more pronounced in the morning. As the morning and days continues on, the normal movements of the body cause fluid to build up in affected joints, having the effect of lubricating the joint and diminishing the symptoms. The facet symptoms may return in the later parts of the day as stress is applied across the joint.

Conservative treatments: Though the first instinct for many people is to restrict movements and exercise when suffering from back pain, in reality one of the keys to treating joints is to get the spine moving again. Conservative (nonsurgical) treatments are designed to re-establish movement in the back. Safe movements and motions that maintain fluidity and lubrication in worn out facet structures are considered by doctors to be the best options for relieving the associated lower back pain.
  • Stretching the muscles of the lower back and upper leg may be effective in minimizing the symptoms associated with facet arthritis. People with this condition in the lower back motion segments should be sure to regularly stretch their back muscles, hip joints, and hamstring muscles.
  • Chiropractic adjustments can help to relief severe pain.
  • When exercises and stretches that are designed to reduce the mobility of the back become difficult on hard surfaces, try to move your workout routine to the pool. Water therapy may help patients to get through their flexibility and strength building exercises while providing them with environments that puts little stress on the joints.
  • For mild cases of pain, cox-2 inhibitor NSAIDS such as acetaminophen may be effective in reducing pain and inflammation.
Surgery for osteoarthritis of the facet joints: In cases where none of these treatments are effective and the patient experiences chronic pain, surgery may be an option. The only effective surgical treatment for this type of osteoarthritis is a fusion. The fusion surgery procedure may be considered that none of the conservative treatments just mentioned or physical therapy is able to reduce the instability or inflammation to that section of the spine. The goal of the surgery is to stop the motion at the painful joint. This type of surgery is more effective when it only required the fusion of one motion segment. Patients who receive multilevel fusions are far likely to experience long term relief as a result of this type of procedure.