Is Facet Arthropathy Serious? Causes & Symptoms

Facet arthropathy is a painful arthritis-like condition of the spine caused by degeneration of the joints between the spinal bones.

The spine is made up of ring-like vertebrae put together in a column. Between each vertebra are two facet joints cushioned by cartilage and lubricated by synovial fluid. The facet joints and spinal disc support each other so that the vertebrae stay in proper alignment and limit movements of the spine.

Facet joints degenerate or wear down with age, leading to facet arthropathy. The cartilage inside the facet joint breaks down, gets damaged, or becomes thinner. This causes the bones in the joints to rub together and move improperly, which causes inflammation, swelling, and stiffness. Pressure on the spinal cord also results in pain. 

Chronic low back pain is often associated with facet arthropathy.

Spinal degeneration is the principal cause of facet arthropathy, and usually occurs due to aging. Factors that may contribute to the condition include:

• Osteoarthritis: Often occurs in older adults due to the degeneration of cartilage in the joints and may affect the facet joints.
• Wear and tear of the facet joints: Wear and tear of the facet joints over time decreases space between vertebrae, causing facet joints to rub together. This leads to inflammation, which triggers pain in the nerve endings of the spine.
• Direct trauma to the facet joint: Trauma caused by impact, accidents, sports injuries, or a fall can cause fractures or ligament tears, damaging one or more of the facet joints.
• Synovial cyst: A fluid-filled sac may develop on the spine, putting pressure on the spinal nerves.
• Damaged spinal discs: Due to trauma, accident, or injury.
• Rheumatoid arthritis: Damages facet joints, particularly mid-lumbar and lower lumbar areas.

Possible risk factors include:

• Age: The condition is more common in older people.
• Sex: Women are more likely to develop facet arthropathy than men.
• Body weight: Risk increases by approximately 3 times for people who have a body mass index of 25-30 kg/m2 and 5 times for people with a body mass index of 30-35 kg/m2.
• Heredity: Some people may develop facet arthropathy due to family history or genetics.

Pain is the most common symptom of facet arthropathy. Features of pain associated with the condition may include:

• Back or neck pain that gets aggravated when bending or leaning backward
• Dull ache on one or both sides of the lower back
• Lower back pain that gets intensified when twisting sideways, lifting objects, or standing
• Pain centered in a specific area of the spine
• Pain that worsens after sleep or rest
• Pain that is relieved with sitting, leaning forward, or changing positions
• Inability to move or stiffness of part of the back or neck
• Other conditions caused by facet arthropathy, such as bone spurs and spinal stenosis, may press on spinal nerves, causing pain down the arms or legs

Disc problems, back injuries, or sprains can cause similar symptoms, making it difficult to know whether the back pain is caused by facet arthropathy or something else.

One or more of the following tests may be used to diagnose facet arthropathy:

• X-ray
• Bone scan
• Computed tomography scan
• Magnetic resonance imaging
• Anesthetic injection, which is administered into the facet joints (if 80% pain relief occurs after the injection, a presumptive diagnosis of facet arthropathy is made)

There is no cure for facet arthropathy. Treatment focuses on relieving pain and stiffness and helping the person remain as active as possible. 

Treatment options include:

• Oral medications: Medications may be prescribed to help reduce inflammation and relieve pain and should be taken under the guidance of a doctor. Oral medications include:
  • Analgesic acetaminophen
  • Corticosteroids
  • Cyclo-oxygenase-II inhibitors
  • Muscle relaxants
  • Nonsteroidal anti-inflammatory drugs
• Avoiding movements that cause pain: Patients should avoid lifting, repetitive twisting, or overextending the lower back.
• Epidural injections: Anesthetic or steroid injection is directly injected into the spine with a needle.
• Radiofrequency ablation: This procedure uses radiofrequency waves to shut down the function of the affected facet joint nerve and prevent it from sending pain signals to the brain.
• Physical therapy: Helps the spine regain strength and movement through strengthening exercises. It helps the spine develop proper posture to avoid additional stress on the backbone.
• Surgery: Surgery may be performed when there is compression of the nerve:
  • Facet rhizotomy: One of the nerves going to the facet joint is severed.
  • Spinal fusion: Two or more affected spinal bones are fused together into one bone to stop the damaged facet joints from moving, which can alleviate pain. Sometimes, facet joints between parts of the spine that are fused together are removed during spinal fusion.
• Other treatment options:
  • Traction
  • Water therapy
  • Spinal manipulation

Although it is not possible to prevent facet arthropathy, the following can reduce the risk of developing the condition:

• Maintaining ideal body weight
• Exercising regularly (regular exercise can help keep the joints moving smoothly)
• Avoiding injury (make sure to not twist the back too much when lifting heavy weights)
• Maintaining good posture
• Quitting smoking
• Eating a healthy, balanced diet
• Taking calcium or vitamin D supplements to keep bones healthy (discuss this with your doctor)