The facet joints are the joint structures that connect the vertebrae to one another. Facet joints provide support, stability and mobility to the vertebrae (spine). Facet joints are covered by a layer of smooth cartilage, surrounded by a strong capsule of ligaments and lubricated by synovial fluid. The cartilage enables bones to glide smoothly over one another. Facet disease occurs when there is degeneration of the facet joint. Facet disease can occur at any level of the spine, but are most common in the lumbar region.
Facet disease is caused by the cartilage in the joints being worn down as a result of wear and tear, aging, injury or misuse. It can be attributed to arthritis of the spine, work, over-use or an accident. Another cause of Facet Disease is spondylolithesis which is when one vertebra slips forward in relation to an adjacent vertebra, usually in the lumbar spine.
The pain is usually well localized. Unlike the pain and numbness caused by a herniated disc or sciatica, it does not usually radiate into the buttocks or down the legs. If left untreated for an extended period, facet joints become arthritic and often develop bone spurs that can decrease the amount of space available for the nerve roots as they exit the spinal canal. This can be a contributing factor in the development of spinal stenosis which does cause pain, numbness, and weakness in the buttocks and legs.
Conservative treatments for facet joint disease include avoiding painful motions such as repetitive twisting, lifting or extension of the lumbar spine. Anti-inflammatory medications help as well. Stretching and strengthening exercises also improve the strength and endurance of the muscles in the lumbar spine.
Coastal Back and Pain Institute also utilizes facet joint injections to relieve the pain and discomfort by reducing the inflammation and synovitis in the area. This is an in-patient procedure performed within our offices. Pain may recur after several months.
If injections do not alleviate pain, we can kill the nerves that surround the effected facet joints without harming surrounding tissue. These procedures use small electrical probes that are inserted through the skin, into the area of the nerves to the facet joints. An electrical current is sent to the tip of the probe to destroy the nerve. This procedure is called radio frequency ablation.
In other situations, surgery may be indicated to relieve the pain of facet arthropathy. This usually occurs when there is evidence of nerve root compression from enlargement of the facet joints or other disorders in the lumbar spine (such as degenerative disc disease, spinal instability or spinal stenosis) that need to be treated with surgery. In the course of most forms of a spinal fusion, the surgeon removes the facet joints between the levels of the spine that are to be fused together, which eliminates the facet joints as a source of future symptoms.