Arthrosis of the facet joints is a severe pathology that leads to a significant limitation of mobility and contributes to the development of degenerative dystrophic changes in the area of the intervertebral discs. Arthrosis is a pathology of cartilage tissues, as a result of which they are destroyed and expose the bone articular surfaces. When performing movements, they rub against each other and various defects (cracks, chips) occur. Bone growths (osteophytes) form in these places. They interfere with normal mobility, injure surrounding soft tissues and cause severe pain.
Facet joints are bone articulations in the spinal region. They provide flexibility - thanks to them a person can bend forward and backward. The facet joints are small in size (about the size of the interphalangeal joints on the fingers). They are present throughout the entire spinal column.
Most often, arthrosis of the facet joints of the spine develops in the cervical and lumbar regions. This is due to their increased mobility and high physical activity during movements.
At an early stage, facet arthrosis does not cause serious discomfort. Pain occurs rarely; more often, patients note stiffness of movement and swelling of the surrounding muscles. After sleeping in an uncomfortable position, you may experience a feeling of pinching of one or another muscle in the area of the affected facet joint. In the area of each vertebra there are two joints of this type. The disease can be unilateral or bilateral.
In men, this degenerative pathology may be associated with the development of ankylosing spondylitis (ankylosing spondylitis). The initial clinical sign of this may be stiffness of movements in the morning, the appearance of crunching and clicking sounds when moving, and the inability to fully bend forward.
In women, destruction of the facet joints can be caused by hormonal imbalance. It often affects women who decide to have a premature termination of pregnancy. It often occurs in women going through menopause and having serious problems with bone destruction (osteoporosis or osteomalacia).
A vertebrologist treats facet syndrome. He conducts a comprehensive differential diagnosis. Pain in the back, lower back and neck can be caused by various diseases. It is important to clarify the diagnosis and direct efforts to restore damaged tissues. Therefore, initial diagnosis is the most important step in treatment.
In Moscow, you can make an appointment for a free appointment with a vertebrologist at our manual therapy clinic. Experienced doctors work here who can make a preliminary diagnosis and develop a plan for further examination. After an accurate diagnosis is made, an individual treatment plan is developed for each patient. You can make an appointment for a free appointment with a vertebrologist by calling the administrator.
Causes of facet arthrosis of the spine
Among the potential causes of the development of facet arthrosis of the spine are degenerative dystrophic changes, injuries, inflammatory and infectious processes, curvature of the spinal column and postural disorders.
Injuries are in first place among the causes of facet arthrosis of the spine in young active people. Falls on the back, ruptures and sprains of ligament and tendon tissue, fractures of the bodies and spinous processes of the vertebrae - all these pathologies can negatively affect the condition of the facet joints.
Professions that involve carrying and lifting significant weights, constant flexion and extension of the torso and neck can be potentially dangerous in terms of increasing the risk of developing such a pathology.
A certain danger is posed by a cicatricial degenerative process in the area of the ligamentous and tendon apparatus of the back. With the help of ligaments, the spinal column and each vertebrae are fixed individually. Tendons are the attachment points for muscles and are subject to stretching and tearing due to excessive physical activity.
Very often, after an injury, ligaments and tendons do not restore their physiological structure, since they do not have their own capillary blood network. As a result of scar deformation, they lose their fixing and stabilizing ability. Torsion or rotation of the vertebral bodies begins. Against the background of instability of the facet joints, the destruction of their internal cartilaginous layer begins. After the bone articular surfaces are exposed, deforming osteoarthritis begins to develop with a sharp limitation of mobility and severe pain.
Other potential causes of facet syndrome include:
- congenital or hereditary weakness of cartilage tissue due to impaired collagen synthesis;
- systemic pathologies leading to the destruction of cartilage tissue (systemic lupus erythematosus, rheumatoid polyarthritis, scleroderma, ankylosing spondylitis, etc.);
- inflammatory processes in the area of intervertebral discs and ligaments;
- degenerative dystrophic disease of the spine (osteochondrosis) and its complications, such as hernia and disc protrusion;
- scoliosis and other types of spinal curvature;
- stoop, round back and other types of poor posture;
- chest deformation;
- incorrect placement of the foot and destruction of large joints of the lower extremities;
- spondylosis and spondyloarthrosis.
- There are risk factors that can trigger the development of pathological changes in the facet joints of the spine. These include:
- metabolic disorders leading to the development of obesity;
- maintaining a sedentary lifestyle, without regular sufficient physical activity on the muscles of the back, neck and collar area (contributes to disruption of the diffuse nutrition of cartilage tissue);
- improperly organized sleeping or working space, as a result of which the process of distributing shock absorption and physical load on the spinal column is disrupted.
At the beginning of treatment, it is necessary to exclude the effect of all unfavorable factors. Finding and eliminating the potential cause of facet syndrome is an important task for the attending physician.
Arthrosis of the facet joints of the C3, C5 and C7 cervical vertebrae
Arthrosis of the facet joints C5 and C7 of the cervical vertebra is often diagnosed - this is due to the fact that during work the muscles of the collar zone are tense. In this case, the pressure is exerted to a greater extent on the C5 and C7 vertebrae. The position of the articular surfaces changes, the load on the joint increases, and it gradually collapses. When working with a head tilt, it is necessary to perform a special set of physical exercises every hour. This is the only way to prevent the development of arthrosis of the C5 facet joints, which makes it difficult to tilt the head forward and back.
In second place in terms of frequency of development is arthrosis of the C3 facet joints - this vertebra most often suffers from traumatic and increased shock absorption. The cause of this type of pathology in most cases is emergency braking when driving a vehicle.
What are the classic symptoms of osteochondrosis?
The classic symptoms of osteochondrosis are back pain during exercise. The first pain occurs in the morning, immediately after getting up, when the spine, after a long rest, is slightly compressed under the weight of the body and the diseased, worn-out intervertebral discs begin to rub against each other. These, sometimes long-lasting pains, increase when forced to remain in one position.
Bends forward and backward also cause pain. Unfortunately, diseased joints show so-called osteophytic reactions. This means that new bone is growing in the facet joints due to a decrease in cartilage mass. As a result, a narrowing of the nerve canals of the spine occurs, the canal puts pressure on the nerve and leads to radiating pain. Thus, with osteochondrosis, along with back pain, pain in the legs is often observed.
Osteoarthritis of the facet joints at L4, L5 and S1 levels
Diagnosing arthrosis of the L4 and S1 facet joints is quite difficult, since its clinical picture often masks symptoms of osteochondrosis. In practice, examinations often reveal concomitant pathology. With it, facet arthrosis l4 s1 is accompanied by a gradual decrease in the height of the intervertebral discs.
First, a degenerative dystrophic change in the intervertebral disc occurs - it decreases in height. Then deformation of the facet joints is observed and arthrosis develops at the l4 s1 level.
Even more often, for this reason, arthrosis of the facet joints l5 s1 is formed - it accounts for more than 70% of all cases of complaints from patients with mobility impairments in the lumbosacral spine.
What treatment methods are there?
In the treatment of osteochondrosis, almost the entire range of conservative treatment methods, including physiotherapy, is used. In parallel, if possible, the causes of the disease are treated. In most cases, this is unfortunately impossible, because... degenerative changes, such as wear of the intervertebral discs, have gone too far and arthrosis of the facet joints causes severe pain.
In this case, symptomatic therapy with cauterization of nerve fibers is used, as described in the Ray thermocoagulation treatment method. The use of this treatment method for one to two years leads to a significant reduction in pain.
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Symptoms of facet joint arthrosis
Clinical symptoms of facet joint arthrosis develop gradually. First, slight pain appears in the area of the destroyed bone joints after significant physical activity. Then stiffness of movement develops, first in the morning, then throughout the day.
Other symptoms include:
- severe pain in the neck, collar area or lower back, occurring against the background of any physical activity or prolonged static tension of the muscle frame;
- a sharp limitation in the amplitude of mobility (with lumbar localization, the patient cannot bend forward and touch the floor with his fingers);
- the appearance of clicks, crunching and other extraneous sounds when trying to make inclined and turning movements;
- excessive tension in the muscular frame of the back and collar area;
- pain in the shoulder joints and limitation of their mobility (with cervical localization of the pathological process);
- during exacerbation and development of the inflammatory process, signs of arthritis appear (swelling, puffiness, hyperemia of the skin, lack of mobility);
- general malaise accompanied by muscle weakness and increased fatigue.
Deforming osteoarthritis gradually forms and mobility in a certain segment of the spinal column is lost.
For diagnosis, a series of radiographic images in different projections is prescribed. They may show destroyed facet joints, dislocation of vertebral bodies, decreased height of the intervertebral disc and other pathological changes. CT and MRI examinations are also used, which provide a more accurate picture of the changes occurring.
Lumbar facet syndrome, symptoms and treatment
The main manifestation of lumbar facet syndrome is local pain in the lower back, aggravated by movements without distant irradiation (unlike radiculitis, when pain spreads from the lower back to the foot). Palpation in the projection of the affected facet joint is also painful.
In the case when, after a comprehensive examination, including a detailed questioning of complaints, a neurological and orthopedic examination, analysis of X-rays and MRI, the doctor suspects lumbar facet syndrome , he traditionally begins with conservative (i.e., non-surgical) treatment methods. Non-steroidal anti-inflammatory drugs, physiotherapy, and immobilization in a semi-rigid corset are prescribed.
As the pain subsides, they move on to exercise therapy, swimming, back massage, but all these activities may have no effect, and the pain may be subacute, only dull, and not go away completely, in which case you can think about RFD (radiofrequency denervation) of the facet joint .
The first step is to block the affected facet joint - this is the main diagnostic test for this disease.
The methodology of the procedure is as follows: in an operating room or treatment room under sterile conditions, under X-ray control, 1 ml of Lidocaine or Novocaine is injected exactly into a special point “terrier eye” with a special long needle. Then the patient monitors the sensations in the “sore” place for 1-2 hours, performing his usual movements - walking, bending. If the pain syndrome completely disappears, the patient is offered a procedure - “radiofrequency denervation of the lumbar facet joints.”
RFD is also performed under aseptic operating room conditions.
or a treatment room with an X-ray machine,
no earlier than one day after the diagnostic blockade. It is necessary for the effect of the diagnostic blockade to completely end. The cannula (needle) is positioned at the passage of the medial branch of the radicular nerve, which provides pain sensitivity to the facet joint; radio frequency is supplied through it, which is converted into thermal energy, thermal destruction of the nerve fiber occurs and, as a result, pain anesthesia of the joint occurs.
It is well known that two adjacent medial radicular branches take part in the pain innervation of one facet joint - one level lower and one higher. It is this circumstance that explains the need for denervation at several levels.
Typically, denervation of one point takes a minute. Thermal destruction causes discomfort, which is eliminated by introducing a local anesthetic through a needle - cannula. After the procedure, the patient can independently, on his own feet, leave the operating room and go home. For a short time he is bothered by local pain at the site of nerve destruction (thermal burn), but by its nature this is a completely different pain and over the course of several days it gradually goes away. The doctor is usually in touch and can give timely recommendations.
Treatment of arthrosis of the facet joints of the spine
Manual therapy techniques are used to treat arthrosis of the facet joints. Unfortunately, successful treatment of arthrosis of the facet joints of the spine is possible only in the early stages, when at least partially the cartilaginous synovial membrane of the bony articular surfaces is preserved. If it is already destroyed and degenerative changes in bone tissue have occurred with the formation of spurs, osteophytes and rough bone calluses, then to successfully restore the mobility of the spinal table, a surgical operation will be required.
In the early stages, treatment of facet arthrosis includes measures to eliminate the potential cause of the development of this disease and create conditions for the complete regeneration of destroyed tissues. Manual therapy allows treatment without the use of potent pharmacological drugs that can cause harm to the human body.
We include the following techniques in the course of therapy:
- acupuncture (reflexotherapy), including pharmacopuncture for rapid pain relief, relief of the inflammatory reaction and triggering the regeneration of all damaged tissues in the joint area;
- kinesiotherapy and therapeutic exercises to strengthen the muscular frame of the back and collar area, which will help restore the impaired diffuse nutrition of the cartilaginous tissues of the spinal column;
- traction traction of the spinal column – helps restore the normal anatomical position of all structural parts, including facet joints;
- laser exposure and other physiotherapy techniques;
- massage and osteopathy to improve microcirculation of blood and lymphatic fluid in the affected area.
Make an initial free appointment with a vertebrologist. The doctor will conduct a full examination, make a diagnosis and give individual recommendations for treatment of this pathology of the spinal column.
Arthrosis of the intervertebral (facet) joints
Facet syndrome is a manifestation of arthrosis of the intervertebral (facet) joints. Arthrosis of the facet joints cannot develop on its own; it is always an advanced degenerative-dystrophic process that affects the intervertebral discs, vertebrae and everything around them. And if they say that it occurs in 15-40% of all patients with chronic lumbar pain, then they clearly significantly underestimate this figure, because this syndrome cannot occur without changes in the intervertebral discs. And all patients with intervertebral hernias have manifestations of arthrosis of the facet joints to varying degrees of severity. So what, everyone needs to be operated on? But who gets better after radiofrequency denervation of the facet joints? We haven't met anyone like that. Why it happens that they continue to treat the symptoms of facet syndrome, and not its cause, is not clear today. Let's try to understand these intricacies of the anatomy of the spinal column.
The vertebral bodies, intervertebral discs, anterior longitudinal ligament are designed to resist gravity, and the transverse and spinous processes, plate, pedicles and intervertebral joints are designed to protect against rotational and displacement forces in the lateral and anteroposterior directions.
The force of gravity in a normal spinal motion segment is distributed unevenly: up to 80% on the anterior sections and up to 30% on the intervertebral (facet) joints.
When intervertebral discs are damaged, their height and shape change, the vertebrae become closer to each other. And naturally, the articular surfaces of the intervertebral joints also become closer, their articular space becomes narrower. Of course, the entire weight load goes to them, reaching 70%. This overload causes changes in them. First, to synovitis with fluid accumulation, and then to degeneration of the articular cartilage, stretching of the joint capsule and subluxation in it. These repeated microtraumas, weight-bearing and rotatory overloads lead to periarticular fibrosis and the formation of subperiosteal osteophytes. Due to this, the sizes of the upper and lower facets increase. Then the joints sharply degenerate and practically lose cartilage. Due to the asymmetry of the process, the load on the facet joints is uneven. Changes in the intervertebral discs and facet joints sharply limit movements in the spinal motion segments.
Pain begins during extension and rotation of the lumbar region due to torsion overloads. The pain is limited to the area above the affected joint in the lumbosacral region, rarely this pain is referred and cramping in nature, sometimes it radiates to the buttock and upper thigh. One of the symptoms of facet syndrome may be short-term morning stiffness, followed by an increase in pain in the evening. Prolonged bending, changing body position, standing for a long time, and straightening the pain intensify, but unloading the spine with certain poses reduces the pain.
Upon examination, the patient reveals smoothness of the lumbar lordosis (and what’s strange here - the curvatures of the spine are formed before the age of 7), curvature and rotation of the spine in the lumbosacral and thoracolumbar regions, pronounced tension in the paravertebral muscles and quadratus muscle on the affected side, muscle tension popliteal fossa and hip rotators. Palpation of the affected joint is painful. With facet syndrome, reflex, motor, and sensory disorders are very rare and the symptoms of “tension” are not characteristic, as with radicular syndrome, and there is no restriction of movements in the legs. Sometimes, in chronic cases, some weakness of the erector spinae and popliteal muscles is detected.
The facet joints are innervated from 2-3 adjacent levels, which seriously complicates the diagnosis.