What is Facet Joint Disease?
Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine

Facet joint disease affects the spine. It is an arthritis-like condition that is characterized by inflammation and degeneration.
The facet joints in the spine allow for movement and flexibility. There are two facet joint sets for every vertebra in the spine. The one set faces upward and downward. The second set is on the left and right of each vertebra.

Each joint is surrounded by connective tissue that essentially acts as a capsule. To lubricate and nourish the joint, they produce fluid. Cartilage coats the joint’s surface to ensure that the joints can move against each other smoothly.

When facet joint disease is present, the bones that make up the joints do not have enough cartilage to allow for smooth movement. This can result in stiffness and back pain when you move or after periods of inactivity.

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More About Facet Joint Disease

lumbar foraminotomy

Cartilage wears down over time, eventually wearing away so much that the bones that make up the joints start to rub together. Over time, bone spurs can develop around the vertebrae and on the facet joints. These bony grows develop to try and return joint stability.

As the disease progresses, the spine starts to lose flexibility and it stiffens. The bone spurs can sometimes become big enough to make the spinal canal narrower. If this happens, the nerves that are in the area can become entrapped or irritated.

You facet joints are constantly working to support an upright, steady posture. Because of this, they can wear down over the years. This is what results in facet joint disease.

 

What are the symptoms?

There are several symptoms you might experience with this condition. The severity varies and typically depends on the level of deterioration the joint has experienced.

Symptoms may include: 

  • Back pain
  • A constant or intermittent aching
  • Tenderness over the area where the problematic joint is located
  • Curvature of the spine
  • A grinding sensation when moving due to the bones of the joint rubbing against one another
  • A constant or intermittent throbbing
  • Locking of the joints
  • Pain when you left, twist or bend 

A reduced range of motion is not uncommon as this condition progresses. Some people also experience muscle spasms.

As the vertebrae compression worsens, this puts more pressure on the facet joints. This can lead to the symptoms becoming more severe over time.

How is Facet Joint Disease Diagnosed?

Pain is the first indicator of a bulging disc that needs attention. Once identified, there are typically four steps to the process

•  Physical Examination:

Doctors usually start with asking the patient about their symptoms and where they are located. This helps to narrow down which facet joint is causing the symptoms. A physical examination that puts emphasis on the back and spine is typically performed. The doctor will likely look for tender areas and to see if any spinal curvature is present.

•  Diagnostic Imaging:

To look at the bones, soft tissues and other spinal structures, imaging studies are common. A general X-ray is usually the first place to start because it is quick and simple. This can identify any vertebrae abnormalities that might be present. This can also help to rule out a vertebrae fracture.
If the doctor wants to get more detailed images, they might recommend a CT scan or MRI. These can show the tissues and more detail regarding the structures.
A bone scan can be done to look more at the facet joints. When a facet joint is inflamed, it will appear as a hot spot on the bone scan.

•  Spinal Injections:

This can also be helpful for diagnosing an issue with a facet joint. This involves injecting a local anesthetic into the facet joint the doctor suspects is causing symptoms. To accurately guide the needle to the right spot, fluoroscopy is used. If the injection causes a reduction in the patient’s pain, this can indicate that the injected joint is the problem. 

Causes of Facet Joint Disease


low back pain

There are a few factors that can cause this condition. Potential causes include:

  • Trauma: Whiplash and other types of trauma may contribute to this condition. Spinal tissues can become overloaded because of abnormal posture. This can cause pain and inflammation in the facet joints. 
  • Degenerative Changes: The most common cause is degenerative changes in the thoracic, cervical and lumbar spine. This can cause abnormal strain and stress on the facet joints. It is less common for this condition to develop in the thoracic spine compared to the cervical and lumbar regions. This is believed to be due to the thoracic spine being more rigid than the cervical or lumbar spine. 
  • Age-related Wear and Tear: The dominant factor in the progression of this condition appears to be aging. This is believed to be due to the wear and tear the joints sustain with normal use throughout your life. 
  • Genetics: Experts believe that there may be a genetic predisposition to this condition. If someone has another familiar member with facet joint disease, they may be at a higher risk for developing it.
  • Other Factors: Working a job or having a hobby that requires repetitive motion, such as bending over and twisting to lift things repeatedly, might increase the risk of this disease. Being overweight is also considered a contributing factor.

How is Facet Joint Disease Treated? 

Conservative Options

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

Decompression

Minimally invasive decompression surgery aims to relieve pressure on the nerves of the spine. This pressure is often caused by stenosis, bulging or herniated discs, and more. Relieving this pressure can be achieved by reducing or removing soft tissue (disc material or scar tissue) or bone (bone spurs, a section of the lamina or foramina) to decompress the affected nerve. When the compression is caused by soft tissue material, a surgical laser may be used to shrink the impinging material.

Fusion/Stabilization

Fusion surgeries are similar in goal–to remove damaged disc tissue and fuse the bones together–but differ in approach, including the use of specialized hardware to reinforce stability, and the location used to gain access to the spine. A related procedure is an artificial disc replacement, in which a damaged cervical disc is replaced with a synthetic disc, and the vertebrae are not fused.

How Much Does Treatment Cost?

Treatment cost depends on several factors, especially what insurance you have and how much of your deductible has been met. IN the last two years, 90% of our patients have paid less than $2000 out-of-pocket. Some have paid literally nothing, and other have paid much more than that. It depends. The good news is: our Patient Care Managers will handle as much as they can directly with your insurance company, and all your costs will be known up-front.

Important note: spine surgery often pays for itself within a year or two. Many people actually spend more money trying to live with the pain than they do getting the pain fixed. The following calculator is intended to give you a sense of what you spend on managing—rather than eradicating—your pain.

 

Calculate how much you've spent on back pain this year.
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This past year you have spent on your pain treatment:

Get surgery now. Getting surgery now is the smartest financial move. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. You’ve spent that much or more this year to manage your back pain than you could to fix it.

Get surgery soon. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. At your current rate, you will spend that much or more within the next two years. The sooner you get treatment, the sooner it will pay for itself.

Keep an eye on your spending. Currently, you are managing your pain efficiently from a financial perspective but over time, your expenses could add up. Surgery should be strongly considered if you start missing more work or spending more on treatment medication.

Great job! You are spending very little on your back pain. Keep it up!

Equipment Used in Diagnosis and Treatment of Facet Joint Disease

It is common for doctors to order imaging studies to get a better look at your spine. A general X-ray creates images using electromagnetic waves. As the tissues absorb the radiation, they appear in different shades of white and black.

A CT scan provides images that are more detailed than a general X-ray. To create the images, it uses a combination of a computer and X-rays. The images that are produced are cross-sectional.

An MRI provides detailed images of the spine and the surrounding structures. This imaging technology uses radio waves, a computer and a large magnet to produce cross-sectional, detailed images of the soft tissues and other spinal elements.

A bone scan uses imaging technology and a radiopharmaceutical to create images of the bones. If 3-D images of the bones are necessary, doctors might opt to use a single-photon emission computed tomography machine instead.

Certain facet joint disease treatment and diagnostic procedures might use a fluoroscope. This is another type of imaging technology that helps the doctor to visualize the spine and surrounding anatomy. The doctor can see the images in real-time on a monitor.

How Does Facet Joint Disease Compare to Similar Conditions?

There are other conditions that may cause symptoms that are similar to facet joint disease. These include:

  • Herniated disc: Between the spinal vertebrae are rubbery cushions that provide shock absorption. It is possible for the jelly-like insides of these discs to push out via a tear in the disc’s exterior. This can cause pain and other symptoms by irritating nearby nerves.

  • Fracture: A fracture in one of the spinal vertebrae can cause pain similar to significant facet joint disease. A fracture usually occurs as the result of trauma.

  • Torn spinal muscle: The tear can be partial or complete. This is a relatively common injury. Overstretching a muscle or lifting something improperly are common causes. This injury may also occur due to trauma, a sudden twist or repetitive movement.

  • Deep infection: A virus, fungi or bacteria can cause infections. A deep infection in the trunk of the body may cause some symptoms that mimic facet joint disease.

  • Radiculopathy: This results from a nerve root getting pinched. This can happen in all three areas of the spine. This typically occurs because of the tissues surrounding the nerve roots undergoing changes.

  • Sacroiliac joint injury: If this joint is inflamed or injured, it can produce pain in the lower back. There are two sacroiliac joints in the body, one in each side of the spine.

  • Piriformis syndrome: This is a type of neuromuscular disorder that is relatively uncommon. It is characterized by the sciatic nerve being compressed by the piriformis muscle. This muscle is close to the upper hip joint in the buttock region.

There are certain abdominal issues that could imitate facet joint issues in the lumbar spine. The same is true for deep anterior neck issues sometimes being mistaken as facet joint problems in the cervical spine. Because of this, it is critical to perform a thorough differential diagnosis to ensure that the correct diagnosis is given.

Analogy: A Bicycle Chain

Your facet joints are like the chains on a bicycle: they help give you motion. If they become swollen from age, misuse, or an injury, they will not be able to function properly. The bike will not move well, and you will feel pain. The same is true when you develop facet joint disease in your spine.

Good Bicycle Chain

Bad Bicycle Chain

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