Facet Arthropathy

What Is Facet Arthropathy?

Facet Arthropathy commonly denoted as FA is an arthritic condition that affects the functioning and structural integrity of the facet joints present in the spinal column which causes immense pain in certain spinal regions like back and neck areas. It is one of the most frequent forms of condition diagnosed in facet pathology [2]. Aging which causes the wear and tear of facet joints or pressure trauma caused through the injury on the back could be an underlying reason behind the development of facet arthropathy.

Facet Arthropathy Symptoms

1. One of the major symptoms in facet arthropathy include chronic pain that might be present at a certain spinal region.

2. The back pain becomes worse with sleep whereas there is some relief when bending or stretching the spine. However, putting pressure on the spine through twisting or heavy weights could worsen the symptoms.

3. Decreased motility or stiffness in the back or neck region depending on the type of area affected.

Types of Facet Arthropathy

Based on the anatomy of the pain and the underlying changes in the morphological structure of the spine, facet arthropathy could be divided into the following types:

Uncovertebral Hypertrophy

Uncovertebral hypertrophy is the enlargement of the uncovertebral joint which is a tiny synovial joint that extends from the lower cervical vertebrae to the superior vertebral body. Commonly known as Luschka’s joint, an uncovertebral joint is one of the common targets for spur growth as well as degeneration of the spine. It is responsible for the controlling of neck muscles and therefore its enlargement in uncovertebral hypertrophy affects the neck region. Its prevalence causes pain in the neck region and stiffness in the neck movement.

What Are Facet (Zygapophyseal) Joints

Facet joints are also known as zygapophyseal joints. A spine consists of vertebrae that features facet joints of two sets. Superior articular facet is the one pair which faces along the upward direction whereas inferior articular facet is another pair that faces towards the downward direction. The facet joints are responsible for the basic function of aligning the vertebrae and stabilizing motions like twisting, alignment and bending of the back spine through counterbalancing the vertebrae’s discs and reducing friction between the bones. In simpler terms, facets are rear regions located at the back of the spine where the joints merge or meet.

Facet Hypertrophy

It is a process in which the facet joints get enlarged that in turn results in the stiffness of the spine responsible for a decline in the functioning of back motion. Its symptoms include pain in the posterior back region and a decrease in the motility of back movements like bending and aligning. However, the pain gets worse after certain movements of the spine like its rotation or extension. Majorly, it is caused due to aging and there are no proper treatment methodologies that could completely eradicate its symptoms.

Bilateral Facet Arthropathy

The two major components of a spine include discs and bones. The region consisting of bones are known as facets and the point at which they connect are known as facet joints. Each facet consists of facet joints that are located on its right and left side. The bilateral facet joints are responsible for transferring pressure loads and are responsible for guiding and constraining motions in the spine as a result of their geometry [3]. Bilateral facet arthropathy implies that there are certain discrepancies causing the enlargement of facet joints on both sides which results in more severe back pain that might have more regions covered in pain.

Lumbar Facet Arthropathy

Lumbar facet joints are present in the posterior region of the spinal axis and consist of highly connecting joint capsules. The degeneration process that causes anatomical or functional changes to lumbar facet joints is known as lumbar facet arthropathy. It typically occurs as a result of obesity, age, overuse of the posterior region, high pressure on joints or poor body mechanics which might be a result of genetics [1]. It is one of the most common sources of pain and accounts for 15 to 45% of pain caused by facet arthropathy [2].

Facet Arthropathy Diagnosis and Treatment

Facet arthropathy could be diagnosed using X-rays, CT scans, bone scans or MRIs[4] in order to get an idea regarding the location and the severity of the affected areas in the spine. Currently, there are no specific oral treatment methodologies that could completely eradicate facet arthropathy. However, maintaining a certain lifestyle that aims on maintaining proper weight and specific physiological exercise could help in controlling its symptoms. Pain caused due to facet arthropathy could be managed through anti-inflammatory drugs like ibuprofen or muscle relaxants like metaxalone. Surgical methods could be used to correct the structural deformities caused due to facet arthropathy that could in turn help in controlling the offset of pain caused by facet arthropathy. Radiofrequency ablation that uses heat to destroy pain nerves could also be used to treat the symptoms of facet arthropathy. Also, cryoneurolysis technique that aims to cause deterioration of the nerve causing pain could also be used to treat facet arthropathy [2].

Facet Arthropathy - References

  1. ^ Mann S. et. al. (2022). Lumbar Facet Arthropathy. Statpearls. Retrieved 31 Oct 2022.
  2. ^ Perolat R. et. al. (2018). Facet joint syndrome: from diagnosis to interventional management. Insights Imaging, 9(5), pp. 773–789. https://doi.org/10.1007%2Fs13244-018-0638-x. Retrieved 31 Oct 2022.
  3. ^ PNicholas J., et. al. (2011). Spinal Facet Joint Biomechanics and Mechanotransduction in Normal, Injury and Degenerative Conditions. The Journal of Biomechanical Engineering, 133(7), pp. 71010–NaN https://doi.org/10.1115%2F1.4004493. Retrieved 31 Oct 2022.
  4. ^ Juerg Hodler, et. al. (2011). The Reliability of Computed Tomography and Magnetic Resonance Imaging Grading of Lumbar Facet Arthropathy in Total Disc Replacement Patients. Retrieved 31 Oct 2022.