The spinal column is comprised of bony elements called the vertebrae which join together through joints called Facet joints. The facet joints are small as compared to other joints (knee or elbow) in the body but has similar structures. These joints are covered by cartilage and in the normal state, they allow almost frictionless gliding of the surfaces over one another. If degeneration, and osteoarthritis affects these joint the normal state of these joints are disrupted with altered function and painful motion.
Osteoarthritis of the facet joints is not an independent process. It is usually coupled with degenerative disc disease and loss of disc height seen on an X-ray. The natural process of the disease is breakdown of the cartilagenous lining of joint leading to a joint that is not congruous with increased friction between the two surfaces causing pain and stiffness with motion. It is not clear weather degenerative disc disease causes facet arthritis or visa versa. It is however more logical to think that as the disc degenerates, more stress is placed on the facet joints leading to arthritis. In fact, arthritis is the body’s attempt at stabilization. As the disease process begins, the body produces more bone in and around the joints call bone spurs. In the final stages of the disease process so much bone is produced that there is very little motion at the joint leading to decreased pain. Unfortunately, this process takes decades to complete and some patients can not wait for cure that nature ultimately provides.
Conservative treatment is the main strategy used to relieve the low back symptoms. These include: Stretching exercises for the back, leg and hip may prevent further progression of the disease process. Chiropractic and acupuncture has helped some patients, however, their mechanism of action has not been fully understood. Anti-inflammatory medications may decrease pain by their chemical actions. Many treatment modalities are available and all seem to have effect on different patients. No one treatment modality has been shown to be superior over another for this specific disorder. The only surgical treatment available today is fusion of spinal segments. Since this disease process usually affects multiple levels, fusion of all the levels is unrealistic. However, facet arthritis could be coupled with other disease processes which may require a fusion operation. Consult your physician for your specific diagnosis and treatment so that a treatment plan can be tailored to your specific needs.
Typically, patients complain of morning stiffness. As activity is begun the body will produce more joint fluid within the joint and decrease the pain produced by that joint. At the end of the day the pain worsens again due to the stress imposed on the joint. However, symptoms may be accompanied with other disease processes which may confuse the diagnosis. Your physician will use judgment, knowledge, and experience to differentiate and provide you with an accurate diagnosis to expedite your treatment and quick return to active fulfilling life.
