FACET ARTHRITIS

What is Facet Arthritis?
Facet arthritis refers to a degenerative change of the joints that affect the structures in the posterior aspect of the vertebral column 1. This results in a complete functional failure of the synovial facet Facet Arthritisjoints. The facet joints provide sufficient flexibility and stability of the spine which locates along with the posterior aspect of the spine.

Facet arthritis occurs when the cartilage surrounds the ends of the joint becomes thin and gradually diminishes. This results in a growth of osteophytes (bone spurs) and bony hypertrophy of the affected joint.

What are the causes and risk factors of facet arthritis?

Degenerative changes of joint due to aging and instability of the spine lead to facet arthritis. This mainly occurs due to physical trauma or/and poor posture associated with many risk factors that can accelerate the condition; such as age, sex, trauma, overweight, degenerative disc disease, and hereditary predispositions 1,2.
The prevalence of facet arthritis varies according to the age of the populations. In patients with old age, lumbar facet joints make up a common source of pain accounting for 15 to 45% 3. A recent study estimated that about 35 to 42% of patients suffered from neck pain due to facet arthritis 4.

What are the symptoms of facet arthritis?

The symptoms of facet arthritis depend upon the number of the facets affected, the severity of their condition, and the involvement of the nerve root 4–6. These include:
• Pain in the upper cervical spine, which transfers up to the occipital region.
• Pain radiates toward the back of the head, ear, or shoulder.
Radiating pain in the lower cervical spine follows down to the shoulder girdle and posterior scapular region.
• Pain in the lumbar spine sustains around the buttock, hip, thigh, and sometimes knee.
• Localized neck pain or back pain after resting or sleeping.
• Tingling in the back and limbs.

How do neurosurgeons diagnose facet arthritis?

The initial diagnosis of the facet arthritis includes a brief clinical presentation and pain patterns of the patients 3. Your physicians may further confirm by:
• X-ray imaging: Radiography and computed tomography (CT);
• Magnetic resonance imaging (MRI);
• Single-photon emission computed tomography (SPECT); and
• Kemp test 4;

What is the treatment for facet arthritis?

Fortunately, most cases of facet arthritis recover with simple non-surgical techniques, which include:
• First-line therapy associated with pain reliever by using acetaminophen, nonsteroidal anti-inflammatory drugs, anti-depressants;
• Muscle relaxants helps to calm muscles and ease pain and tightness 2;
• The topical therapy with hot or cold fomentation reduce pain;
• Injection of corticosteroid or radiofrequency ablation recommended when conservative treatment did not respond well;
• Physical therapy includes correction of posture, stretching, and strengthening of the abdominal and lower back muscles;
Fluoroscopy in facet block used to treat pain;
• Injection of platelet-rich plasma (PRP) or bone marrow concentrate;

Finally, surgical intervention required for a long-standing case. The most common complicated case occurs when facet arthritis associates with spinal stenosis or herniated discs that produce unbearable pain, loss of motor function, or incontinence 4.

References
1. Evans, D. P. & Evans, D. P. Osteoarthritis of the facet joints. Backache its Evol. Conserv. Treat. 9, 157–159 (1982).
2. Klekot, D., Zimny, A., Czapiga, B. & Sasiadek, M. Isolated septic facet joint arthritis as a rare cause of acute and chronic low back pain – A case report and literature review. Polish J. Radiol. 77, 72–76 (2012).
3. Perolat, R. et al. Facet joint syndrome: from diagnosis to interventional management. Insights Imaging 9, 773–789 (2018).
4. Facet Arthritis – StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK493233/.
5. Thipse, J., Anap, D., Shete, D. & Diwate, A. Prevalence of chronic facet arthropathy: a retrospective study. Int. J. Res. Med. Sci. 2, 193 (2014).
6. Gonzalez, J. C. A. Validation of a New Clinical Sign of Lumbar Facet Syndrome Tt – Validación De Un Nuevo Signo Clínico Del Síndrome Facetario Lumbar Tt – Validação De Um Novo Sinal Clínico Da Síndrome Da Facetária Lombar. Coluna/Columna 17, 303–307 (2018).

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