Like any joint, the facet joints can develop arthritis. This type of arthritis is called facet arthropathy. It may also be called facet joint osteoarthritis (FJOA).
The facet joints, which are located along the back of the spine, keep special bones called vertebrae together and allow for a range of motion in the spine.
Facet arthropathy occurs when the facet joints degenerate or become worn down. In particular, the protective cushion between the facet joints that are made up of cartilage and fluid may become thinner or damaged through wear and tear.
As a result, the bones in the joints may rub together or not move as they should, which causes pain, swelling, and stiffness.
And though there is no cure, treatment for pain and stiffness can significantly improve quality of life.
Facet arthropathy is thought to be a common cause of back or neck pain in older adults.
Facet arthropathy happens when the cartilage between the facet joints breaks down or gets damaged. This may be caused by:
- Osteoarthritis. This degenerative disease is a result of the wearing down of cartilage in the joints. Although it is most common in the hips and knees, it can affect any joint, including the facet joints.
- Accidents or injuries. A car accident, sports injury, or a fall can damage one or more of the facet joints, leading to facet arthropathy.
- Wear and tear on the facet joints. Heavy lifting, improper posture, and disc problems are some of the factors that can cause the cartilage to wear down.
Pain is the most common symptom of facet arthropathy. People with facet arthropathy may experience:
- pain in the back or neck that is worse when bending or leaning backward
- back pain that is aggravated by twisting the body or lifting objects
- stiffness or the inability to move part of the back or neck
It can be difficult to know whether back pain is caused by facet arthropathy or something else.
Other problems, such as back muscle injuries, sprains, or disc problems can cause similar symptoms, and the pain can vary greatly from person to person.
There is no single, obvious cause for facet arthropathy. Risk factors may exist, but they vary depending on which area of the back is affected.
Facet arthropathy in the neck
The top of the spine contains the vertebrae of the neck and is known as the cervical area of the spine. Facet arthropathy that affects this area does not appear to have obvious risk factors.
However, no studies have looked at whether strenuous activities, such as lifting, pulling, or carrying, might cause cervical facet arthropathy.
Lumbar facet arthropathy
The lumbar area of the spine is located in the small of the back, where the spine curves in. This area is designed to support much of the body's weight. The vertebrae in this area are bigger and wider than other vertebrae in the spine.
Facet arthropathy that affects the lumbar area may have several risk factors, though more research is needed to confirm them.
Possible risk factors include:
- Age. Lumbar facet arthropathy is more common in older people.
- Sex. Women are more likely than men to develop lumbar facet arthropathy.
- Ethnicity. African Americans are less likely to develop lumbar facet arthropathy.
- Body weight. The risk of lumbar facet arthropathy is approximately three times higher for people who have a BMI of 25–30, and five times higher in people with a BMI of 30–35.
Some people may be prone to developing facet arthropathy due to their genetics or have a family history of the condition. Heredity may play a role in the breakdown or degeneration of discs in the back, which can lead to facet arthropathy.
Other forms of osteoarthritis may occur alongside facet arthropathy. These other types of osteoarthritis, which may affect the hip and knee, are linked to genetics. It is possible that facet arthropathy also carries this risk factor.
A doctor can make a diagnosis of facet arthropathy using imaging tests. These tests look at the bones and joints in the spine to identify damage to the facet joints.
To diagnose facet arthropathy, a medical professional may use one or more of the following:
- bone scan
- computerized tomography (CT) scan
- magnetic resonance imaging (MRI)
The results of these tests can reveal which facet joints are damaged, if any, as well as the severity of the damage.
Treatment for facet arthropathy focusses on relieving pain and stiffness and helping a person stay as active as possible.
Treatment may include:
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin, and naproxen. These medications help relieve pain and reduce inflammation. People should take these medicines under the guidance of a doctor.
- Physical therapy, which can help a person regain some strength and movement in the spine through special exercises.
- Radiofrequency ablation. This procedure uses radiofrequency waves to shut down a nerve in the affected facet joint. This stops the nerve from sending pain signals to the brain.
- Anesthetic injections. This is when a doctor uses a needle to inject a pain reliever or anesthetic directly into the spine.
- Spine surgery. A procedure known as spinal fusion can be used to fuse the affected spinal bones together into one bone. This can alleviate pain by stopping the damaged facet joints from moving.
Although it is not always possible to prevent facet arthropathy, there are steps a person can take to reduce their risk of developing it. These include:
- Maintaining a healthy body weight. Being overweight increases the risk of osteoarthritis and facet arthropathy.
- Exercising regularly. Walking, swimming, and other low-impact activities are easy on the joints and can help keep them moving smoothly.
- Avoiding injuries. Accidents happen, but some injuries can be avoided with proper precautions. A person should wear protective gear when playing sports, use proper lifting techniques, and avoid lifting objects that are too heavy.
- Maintaining good posture. A person should be mindful of keeping the back straight when sitting, standing, and walking.
- Quitting or not starting smoking. Smoking is harmful to the body's tissues and bones.
- Eating a healthful diet. A balanced diet of fruits, vegetables, whole grains, and lean protein contains nutrients that the bones and joints need.
- Trying supplements. Some people may benefit from calcium or vitamin D supplements to keep bones healthy. People should always discuss supplements with a doctor before taking them.
Unfortunately, the facet joints cannot heal once they become damaged. This does not mean, however, that there is no chance for relief.
Many treatment options exist to help manage the pain of facet arthropathy, including medications and physical therapy.
Working with a healthcare professional and following an individualized treatment plan can increase the chance of leading a healthier, more active life.