A disease such as arthrosis of the facet joints of the spine can rarely be found in a patient’s outpatient chart. It is quite difficult in differential diagnosis. Therefore, in case of characteristic jadoba, the doctor prefers to diagnose the familiar osteochondrosis. In fact, arthrosis of the facet joints is a pathology that, with proper examination, can be detected in 70% of modern urban residents who have crossed the age line of 45 years. And after reaching the age of 60 years, arthrosis of the facet joints occurs in 95% of the examined patients.
The development of the disease is due to a number of reasons. Among the most common negative influence factors, doctors cite excess weight, a sedentary lifestyle and lack of regular physical activity on the muscular frame of the back.
Regular attendance at manual therapy sessions allows not only to avoid the development of arthrosis of the facet joints of the spine, but also to restore the natural mobility of the spinal column to a physiological extent at any age. If you have back pain with limited range of motion, a feeling of stiffness in the morning and rapid fatigue of the muscular frame of the spine, then we invite you to a free initial consultation at our manual therapy clinic. We see experienced vertebrologists, neurologists, osteopaths and chiropractors. The initial appointment for each patient is provided completely free of charge.
During the initial free consultation, the doctor examines the patient, establishes a preliminary diagnosis, and gives individual recommendations for further diagnosis and treatment.
Definition
The spine consists of 33 vertebrae: 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 sacral vertebrae and 4 or 5 coccyx vertebrae . The sacral and coccygeal vertebrae form separate groups of bones connected by a joint, while the others, with the exception of the first two cervical vertebrae, are connected to each other by intervertebral discs, facet joints and ligaments. These connections allow a person to stretch, bend, and turn to the sides. In front, the vertebrae support each other with their underlying mass or vertebral body, with intervertebral discs located between the vertebrae. Posteriorly, the vertebrae on each side are connected by facet joints. The facet joint consists of: fibrous capsule, synovial membrane, hyaline cartilage and bone. If the intervertebral disc loses height, the friction and restriction of mobility that occurs between the bones gradually leads to degeneration of the surrounding tissues, resulting in painful sensations called facet syndrome.
Facet joints of the spine and their facets
To understand the essence of this pathology and the factors of its development, it is necessary to familiarize yourself with the basics of anatomy. The spinal column is a flexible structure that provides not only support for the entire body, but also flexibility and mobility of the torso. Due to the special structure of the spine, a person can make body turns, bends in different directions, twisting and a number of other active movements.
The spinal column consists of:
- vertebral bodies with spinous processes;
- intervertebral discs, consisting of cartilage tissue and ensuring uniform distribution of shock-absorbing load;
- uncovertebral joints;
- facet joints with pronounced process facets.
It is the facet joints that provide attachment of the spinous processes to each other. And due to this, it becomes possible to make various movements with the body and head.
Normally, the facet joints of the spine are covered inside with a cartilaginous synovial layer. A dense joint capsule ensures stability of the facets. And synovial fluid creates ideal conditions for the heads of bones to glide easily during various movements.
The facets of the facet joints have a certain structure that prevents their rapid destruction during injury. But with prolonged exposure to excess body weight or curvature of the spinal column, these bones quickly collapse and become deformed. It is for this reason that people who are used to slouching and holding their back unevenly suffer from crunching and pain with any movement. This indicates that the facets of the facet joints of the spine are destroyed. If complex treatment is not started in a timely manner, the disease quickly progresses and leads to impaired mobility.
The blood supply to the facet joints and their structural parts (cartilaginous, synovial, connective, bone tissue) is carried out through diffuse exchange with the surrounding muscles. To do this, the muscular frame of the back must be subjected to constant physical activity. During muscle fiber contraction, fluid is released, which is absorbed by the cartilaginous structures of the joints and intervertebral discs. If the muscles do not work, then diffuse metabolism is disrupted.
The process of dehydration of cartilage and synovial tissue begins. This becomes the beginning of a destructive process. At first, tight mobility is observed, then, as the cartilaginous layer thins and the bone tissue is exposed, it begins to crack and fill with deposits of calcium salts.
Symptoms
When the facet joints degenerate and become compressed, facet syndrome can cause pain in the cervical, thoracic, or lumbar spine . Depending on the damage to the joint, the pain may be bilateral or on one side. As a rule, pain most often appears in the lumbar spine, since it bears the load of the overlying body. But the pain can also radiate to the buttocks, groin, along the back of the thigh (lumbago) or to the lower and even upper limbs . If facet syndrome occurs in the cervical and thoracic regions, then the pain radiates to the upper extremities and to the thoracic or abdominal regions, respectively . Another possible symptom is loss of sensation in the arms and legs . Inflammation of the joints can also cause stiffness and difficulty straightening and rising from a sitting position . The pain may worsen with physical exertion or heavy lifting, standing for long periods of time, turning, bending, or lateral stretching. Pain may be relieved by lying down or bending forward.
Diagnostics
Facet syndrome is suspected when there is pain in the cervical spine and arms, in the thoracic region or lumbar region even during rest, other characteristic symptoms are present, and neurological and additional studies are negative (when there are no other possible causes for these symptoms on MRI, CT and EMG ). In this case, a diagnostic injection . local anesthetic is injected using an x-ray machine into the area near the facet joint nerve, which is believed to be the source of the pain . If the pain decreases after the injection, then a diagnosis of facet syndrome is made .
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Causes
Lumbar facet syndrome typically occurs due to degenerative changes in the vertebral joints and joint tissues , such as osteoarthritis, degenerative changes in cartilage that occur over time in the facet joints. The syndrome can also develop due to functional disorders in the joints (for example, decreased height of intervertebral discs with or without hernias), blocking and limitation of mobility. Or other pathologies (hernia or protrusion of discs, cysts, etc.).
Osteoarthritis of the facet joints
Facet blockade
- Cost: 10,500 rub.
- Duration: 15-30 minutes
- Hospitalization: 2 hours in hospital
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Osteoarthritis of the facet joints is not an independent disease. It occurs as a result of degenerative processes occurring in the intervertebral discs and the tissues that surround them.
The onset of the disease is expressed in pain that occurs during extension and rotation of the lumbar region. They are localized over the affected joint and sometimes project into the buttock and upper thigh. One of the clinical manifestations of this disease is short-term stiffness in the morning and increased pain in the evening.
Risk factors
Risk factors for the development of facet syndrome in the lumbar spine may include:
- Efforts or postures that contribute to wear and tear on the facet joints over time.
- Age: With the aging process, the risk of wear and tear on the facet joints increases.
- Other pathologies: even when they are not directly related to the facet joints, other pathologies can affect the appearance of the syndrome if they affect the wear of the joints.
Treatment
The main methods of treatment for facet syndrome: – Conservative treatment: may consist of several approaches, including: relocalization of the joints through spinal manipulation and exercise therapy to develop flexibility and strengthen the muscles. If these treatment methods are ineffective, move on to the next one. – If conservative treatment does not work, sometimes treatment can be continued by infiltrating anesthesia and cortisone into the area of the damaged joint. – The final relief from painful symptoms in facet syndrome occurs due to damage to the nerve of the facet joint, which stops the transmission of the pain impulse. There are several techniques, such as radiofrequency ablation of nerve endings. – According to the Filum System® method: Facet syndrome often appears in patients with filum terminale disease . The force of tension on the spinal cord, which is present in this disease, also affects the overload and wear of the facet joints. Therefore, before treating facet syndrome, we screen the patient for signs of filum terminale disease using the Filum System® method so that, if detected, we can first release the tension and then proceed to treat the facet syndrome. To treat facet syndrome, we use electrocoagulation of nerve endings, the results of this treatment are successful.
Hypertrophy and deformation of facet joints
Based on the results of an MRI examination, hypertrophy of the facet joints is often detected, which is a direct clinical sign of the development of the initial stage of arthrosis or spondyloarthrosis.
Spondyloarthrosis of the facet joints begins with primary dehydration of cartilage tissue. Then the thinning of the synovial layer begins. As a compensatory reaction, hypertrophy of the facet joints begins, which means a total uniform growth of bone tissue in the form of deposition of calcium salts.
Such deformation of the facets of the facet joints is considered an irreversible process, since there are no pharmacological drugs that would be able to return the physiological shape of the facets after their hypertrophy. In fact, at the initial stage it is possible to reverse this pathological process. For this purpose, manual therapy techniques are used:
- massage and osteopathy restore microcirculation of blood and lymphatic fluid in the area of tissue damage;
- reflexology starts the process of tissue regeneration by using the body’s hidden reserves;
- Therapeutic gymnastics and kinesiotherapy ensure uniform development of the muscular frame of the back, due to which the diffuse nutrition of all cartilaginous tissues of the spinal column is completely restored.
If you require treatment for arthrosis of the facet joints, then you should not resort to the use of non-steroidal anti-inflammatory drugs. They effectively relieve pain and stiffness of movement only in the early stages of the disease. Then their effect is completely neutralized and the patient requires injections of corticosteroids. These drugs also have anti-inflammatory and analgesic effects. However, they have an unpleasant side effect - they wash away calcium from bone tissue and provoke the development of osteoporosis. With arthrosis of the arcuate joints, this is fraught with acceleration of the process of destruction of bone tissue and loss of performance.