Arthrosis of the facet joints of the lumbar spine: diagnosis and treatment

Arthrosis of the facet joints of the spine is a chronic relapsing disease accompanied by their gradual destruction. At the initial stage of degenerative-dystrophic pathology, damage to cartilaginous tissue occurs, and then destructive changes affect the synovial bursa, ligamentous apparatus, bone structures and periarticular muscles.

The causes of the development of the disease are varied - from severe spinal injury to natural aging of the body. The leading clinical sign of arthrosis is pain that increases with movement . Often the course of the pathology is complicated by neurological disorders that require additional treatment. Various instrumental studies are used in diagnosis - radiography, MRI, computed tomography. Conservative therapy for arthrosis of the facet joints of the spine is practiced. If severe damage is detected, surgery is performed.

Characteristic features of the disease

Arthrosis of the facet joints of the lumbar spine is a polyetiological disease, that is, its development can be caused by numerous external and internal unfavorable factors. Arthrosis is diagnosed in 90% of cases in patients over 50-55 years of age . At this age, recovery processes slow down significantly. With the development of destructive pathology in the body of a young person, chondrocytes begin to be produced to eliminate damage to cartilage and bone tissue. In old age, this process slows down and is aggravated by insufficient production of collagen and elastin.

CT.

But the disease has become “younger” and is now often found in people under 30 years of age. Rheumatologists, vertebrologists, and orthopedists associate this with a sharp decrease in motor activity and a sedentary lifestyle. Young people who prefer to spend time at the computer often suffer from back pain that precedes arthrosis of the facet joints.

Prevention

Unfortunately, after 60 years of age, osteoarthritis of the spine occurs in most people. To stay healthy as long as possible, doctors recommend:

• take vitamin complexes;
• control weight;
• treat chronic diseases.

If you are worried about pain in your spine, do not put off going to the doctor. Appointments with a medical specialist are available 24 hours a day. Remember, the sooner treatment for spinal osteoarthritis is started, the greater the chances of returning to a healthy life and forgetting about pain.

Causes and provoking factors

In addition to natural aging, the development of arthrosis is caused by frequent and prolonged stress on the spine - excess body weight, heavy lifting, grueling sports training. Doctors include in this group a violation of the relationship between the anatomical structures of the spinal column. Such congenital anomalies cause a redistribution of the load on other joints, which leads to their gradual destruction. The following pathologies in the structure of the spine are especially dangerous:

• lumbarization - partial or complete separation of the first sacral vertebra from the sacrum;
• sacralization - complete or partial fusion of the fifth lumbar vertebra with the sacrum;
• violations of joint tropism - asymmetrical arrangement of facet joints;
• improperly formed vertebral arches;
• violation of the attachment of arches to the vertebral bodies.

Many people are not even aware of the abnormal structure of their vertebrae. This is clarified when diagnosing already developed arthrosis or when undergoing a regular medical examination. In a person with such congenital anomalies, the load on the lumbosacral spine increases, causing rapid wear of the joints.

The disease can develop after severe trauma to the spine (fracture) or frequent microtrauma, for example, when lifting and carrying heavy objects. Especially often, post-traumatic arthrosis of the facet joints is diagnosed in untrained people who decide to actively engage in sports. The following factors can provoke degenerative-dystrophic pathology:

• posture disorders;
• sitting for a long time;
• flat feet;
• diseases caused by metabolic disorders.

The sacrolumbar spine experiences increased static loads. Therefore, often simultaneously with arthrosis, other pathologies localized in this area are detected - osteochondrosis, spondyloarthrosis.

Clinical picture

The main clinical manifestation of arthrosis of the facet joints is pain that intensifies during movement and subsides when lying down. Unlike a hernia or osteochondrosis, the pain syndrome is localized in areas of damage to the facet joints and does not spread to adjacent parts of the body. The pain is usually dull, aching, prolonged, intensifying with a sudden change in weather, hypothermia, or exacerbation of chronic pathologies. The disease is characterized by other severe symptoms:

• swelling at the site of injury, usually occurring in the morning and disappearing during the day;
• morning stiffness that persists for 40-60 minutes;
• an increase in the intensity of the pain syndrome when staying in one position for a long time;
• frequent subluxations of the facet joints, the restoration of which is accompanied by characteristic clicks.

In the absence of medical intervention, destructive and degenerative changes spread to healthy tissue. The late stage of pathology is characterized by the formation of bone growths - osteophytes. With cervical arthrosis of the facet joints, they can disrupt innervation and provoke the development of radicular syndrome. The pain is no longer localized in the cervical vertebrae, but radiates to the back of the head and neck, forearm, and clavicle area. Compression of the nerve roots in the lumbar spine and stenosis of its canal manifest themselves in increased weakness and numbness of the limbs. Painful sensations radiate to the buttocks, thighs, and legs.

Kellgren's disease is an arthrosis that affects both the facet and peripheral joints and is more often diagnosed in women. This pathology is characterized by the destruction of a large number of joints (four or more), localized in various parts of the spine. The disease is often accompanied by the formation of protrusions and intervertebral hernias, damage to the ligamentous-tendon apparatus.

Types of spinal osteoarthritis

The following types of osteoarthritis are distinguished:

• Primary, or idiopathic – affects the cartilage tissue of the joints for no apparent reason;
• Secondary – develops as a result of existing diseases, joint dysplasia or as a result of an inflammatory process, injury, endocrine disorders;
• Localized – affects one joint;
• Generalized – characterized by multiple joint lesions;
• Deforming - accompanied by changes in the ends of the bones that come into contact with the joints, leading to pronounced changes in the shape of the joints, disruption of their function and the appearance of severe pain.

Uncovertebral osteoarthritis of the cervical spine is one of the types of deforming arthrosis. The pathological process develops in the facet joints and affects 1-2 cervical vertebrae. Bone growths form on their posterolateral surfaces.

Diagnostics

At the initial stage of diagnosis, the doctor listens to the patient’s complaints, performs an external examination, and studies the anamnesis. Pathology may be indicated by previous trauma, chronic diseases of the joints - rheumatoid or psoriatic arthritis, gout. A history of diabetes mellitus and thyrotoxicosis is also a clue. The clinical picture of damage to the facet joints is similar to the symptoms of many diseases of the musculoskeletal system - osteochondrosis, radiculitis, intervertebral hernia. Therefore, differential diagnosis is required using instrumental studies:

• radiography;
• magnetic resonance or computed tomography;
• ultrasound examination.

Arthrosis and osteophytes on x-ray.

X-ray images are the most informative. They clearly show changes in the structure of joints characteristic of arthrosis - narrowing of the joint space, osteophytes, subluxations and microcracks. The patient is prescribed a laboratory blood test to determine the level of uric acid, fibrinogen, and erythrocyte sedimentation rate. Biochemical examination of punctate allows one to determine the presence of infectious agents in the cavity of the facet joints.

Methods of treating the disease

Therapy for arthrosis of the facet joints of the spine involves eliminating pain and preventing further tissue damage. Patients are advised to wear rigid fixation corsets to ensure optimal load distribution. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce the intensity of pain. Muscle relaxants are used to relax muscle muscles and relieve painful spasms. High clinical effectiveness is characteristic of NSAIDs in the form of ointments and gels:

• Voltarena;
• Fastuma;
• Apizarthron;
• Indomethacin;
• Ketoprofen.

After their local application 2-3 times a day, pain, swelling, and hyperemia quickly disappear. If NSAIDs are ineffective, hormonal drugs are included in the therapeutic regimen, especially when acute inflammation in the joints is detected. The duration of glucocorticosteroid therapy is determined by the doctor, but treatment rarely lasts more than 3-7 days due to the pronounced side effects of these drugs.

If conservative therapy does not produce the desired result, the patient is prepared for surgery. It involves installing special implants between the affected vertebrae. Often, doctors immediately insist on surgical intervention, bypassing a course of medications. In such situations, it is worth listening to their recommendations, since arthrosis of the facet joints progresses rapidly.

Physiotherapy for arthrosis

As a comprehensive treatment for the disease, patients are prescribed physiotherapeutic procedures. They must be carried out in a hospital setting under the strict guidance of the attending physician. With their help, you can reduce the load of medications on the patient’s body, as well as enhance the effect of the main method of therapy. Among them, the most effective are the methods given in the table.

If you have arthrosis of the facet joints, you should not self-medicate. To eliminate damage to vertebral structures, you need to seek help from a specialized specialist. This will help make the treatment comfortable and safe for the patient’s health.