What can be done to relieve facet joint hypertrophy and pain in my back?

Spinal Facet Joints or Zygapophyseal Joint Hypertrophy

A lot can be done to reduce or eliminate pain and related symptoms of facet hypertrophy and facet arthropathy, depending on the degree of involvement.  First, it is necessary to know more a bit more about the problem so treatment can be most effective.

Facet joints (zygapophyseal joints) are the small flat vertical joints found on the rear or posterior area of the spinal vertebra that align themselves with facets of adjacent vertebra. The joining of facets from two adjacent vertebra stabilizes and assists limited movement of the spinal bones.   This special kind of joint is found in all areas of spine: cervical (neck), thoracic (upper back) and lumbar (low back).

Facet joints are found at all levels of the spine, supporting and bracing the spine while allowing free movementFacets are like cartilage-lined hinges that hold adjacent vertebrae together, but still allow movement. The facet joints are located at the upper (superior) and lower (inferior) portion of each vertebra of the spinal column’ there are two facet joints at the upper portion and two at the lower portion of each spinal bone.  The upper and lower facets are connected to meet or pair up with the upper and lower facet joints of the vertebrae above and below each spinal vertebra.

This arrangement of the two facets meeting (one from the vertebra above and one from the vertebra below) is much like when placing the two open hands together in prayer so that the palms face each other; one palm is placed against the surface of another palm to form a unit. In the spine these facets form similar paired units that link and lock the spinal bones together while still allowing movement when the facets slide across each other.

The zygapophyseal joints, or facets, are designed to provide support, stability, and flexibility to the spine.With the discs holding the vertebra in position from the front, and the facet joints maintaining the position of the Spinal facet joints are made by the meeting of the zygapophyseal process of one vertebra with the zygapophyseal process of another. vertebra from the back, the spinal bones are held firmly in place while still allowing for movement.

The movement that a facet joint allows is determined by the angle and degree of orientation of the pair; not all pairs face in the same angle and degree, depending on the particular area of the spine.  As the spinal vertebrae are interconnected by the facet joints the spine is able to flex, extend and rotate within a prescribed range of motion that is limited by the facets themselves. This arrangement of paired facet joints uniting adjacent vertebrae allows for just enough movement to allow full function of the spine but not so much movement that might injure the spinal cord or spinal nerves.

Each of the facets is covered with dense and smooth articular cartilage, that allow them to glide across each other back and forth. This is why this type of joint is called a gliding joint.  The joint created when two of these facets meet is surrounded by an articular joint capsule that produces a lubrication (synovial) fluid to reduce wear when the joints slide across each other, thus helping spinal movement and stability. Each facet joint has a double nerve supply; one nerve originates from at the level of the facet joint while the second nerve originates from the spinal level above it.

Causes of facet joint pain

Pain can arise from a facet joint due to local inflammation of the facet joint from a variety of causes (injury, arthritis, infection) or due to mechanical nerve pressure or impingement. With age or continued abuse of the cartilage or joint capsule of the facets can lead to irreversible breakdown, or degeneration, of a zygapophyseal or facet joint.  When degeneration is allowed to continue the joint is said to become arthritic, resulting in reduced movement, pain and swelling of the local area. Common causes of facet joint pain are:

  • Normal aging process
  • Heavy trauma or repeated injury causing a fracture of the facet from the body of the vertebra
  • Overuse or abuse that results in premature tissue breakdown
  • Genetic predisposition
  • Weakened immune system
  • Spondylolisthesis
  • Obesity
  • Excessive weight being lifted, repeated lifting or incorrect lifting technique
  • Poor posture a work or rest

There are several ways that doctors explain the different stages or degrees of arthritis that eventually lead up to a full blown case of arthritis in the facet joints.  Since there are those times in which it is necessary to modify the diagnostic or descriptive terminology slightly to accurately explain or describe a patient’s problem, a slightly different word picture is created with the following terms, although most of the time it comes down to the fact that the facet joint is not normal and is displaying signs of arthritis.

Facet joint disease – general term

Facet joint disease can also be called a facet joint disorder or a facet joint syndrome.  This diagnosis is an extremely common way of indicating non-specific back pain and neck pain due to a minor problem of the facet joint .

This is the most general and broad term to indicate there is a problem with the facet joint, and it is meant to be nonspecific.  When facet joint disease is used to describe a problem it means that the facet joint is the source of the pain and other symptoms, but the exact nature of the problem has not or cannot be determined.  Using this term might indicate that the problem is very minor at the time or that the problem is determined to be in the facet structure but the exact diagnosis has not yet been determined in which case facet disease is used until a more specific diagnosis can be made.

It is speculated that many cases of facet joint disease are simply a very early stage of spinal or facet arthritis that has not yet produced sufficient bone or joint changes to be seen on MRI or x-ray examination.

Facet joint effusion

The term facet effusion means that there is an accumulation of excess fluid within the facet joint, usually related to the edema or swelling that occurs when arthritis or injury affects an area.  Magnetic resonance imaging (MRI) techniques are best to show facet joint effusion, but it can be detected on standard x-ray examination to a lesser extent.

Facet joint effusion occurs in about 80% of all cases of low back pain as one of the basic findings that explain the source of the pain, along with edema and swelling of the ligaments that are connected between the spinal bones.

Facet arthropathy, facet osteoarthropathy and facet arthrosis

No evidence of facet arthropathy in a healthy area of the spine Facet arthropathy, facet arthrosis, facet osteoarthropathy and facet osteoarthritis are different terms for the same process or problem.

Facet osteoarthropathy or arthropathy is just another way of saying osteoarthritis of the facet joint.  Facet osteoarthritis is the common form of degenerative arthritis that occurs as we age, causing a breakdown of the cartilage between the facet joints of the spine.

Physical examination and x-rays are needed to make this diagnosis based on evidence of facet joint degeneration and swelling.

Facet arthropathy is the result of spinal arthritis and joint effusion eventually developing into facet osteoarthritis. The pain of facet osteoarthropathy tends to be minimal to moderate during the early hours of the day when the buildup of fluid (effusion) in the joints is lowest. However, as the day progresses and continued stress is applied to the facet joints during normal daily activities of living the pain tends to increase. The pain tends to be localized near the areas of joint involvement near the midline of the body, causing a small or large area of the neck or low back to be painful.

Facet joint osteoarthritis usually does not result in symptoms of nerve compression.  However, when a bone spur or facet hypertrophy (next) develops very near a nerve at the edge of the facet joint, this additional bone tissue can rub or impinge upon a nerve and cause numbness, tingling, and muscle weakness, in addition to pain.

Facet hypertrophy or zygapophyseal hypertrophy

Facet joint hypertrophy is a term used to describe the thickening or enlargement that the facet joints undergo as osteoarthritis develops in the spine. The facets may become enlarged as part of the body’s response to the weakness and instability that occur as a consequence to the degeneration of the spine; as arthritis makes the spine more unstable by the wearing down and irregularities in the vertebra the facets respond by increasing in size in an attempt to make the spine more stable.  The facets become larger and thicker to provide additional support in response to the broad degenerative disc disease changes and irregularities of the articular cartilage.

This joint enlargement can proceed to the point that physical pressure and compression is applied to the nearby nerves as they exit the spine, and this in turn can cause pain to be felt either locally or anywhere along the length of the nerve, as in the case of sciatica that starts in the low back but is felt in the leg or hand problems that start in the neck but is felt in the arm or hand.

Common symptoms of facet hypertrophy are pain, stiffness of the involved area of the spine, reduced range of motion and numbness in the extremities.

Enlargement of the facet joints is most commonly associated with osteoarthritis and degenerative joint disease.  As the cartilage lining of the flat surface is worn away, the body compensates and reinforces the area by laying down extra bone that are called bone spurs, making the joints thicker and larger in some areas.  Less commonly facet hypertrophy can be caused by rheumatoid arthritis when the synovial layer of the joint capsule becomes inflamed and thickened. Thus, either by inflammation or extra bone growth, facet joint “hypertrophy,” or “enlargement,” can occur.

Symptoms of facet arthropathy

  • Abrupt onset of spinal pain at and near the level of zygapophyseal disease
  • Pain often at rest, and almost always pain during movement that involves the facet joints anywhere in the spine.
  • Muscles spasms in the adjacent areas near the spine, resulting in a purely defensive or guarded posture. The defensive spasm of joint disease occurs to protect the spine and spinal nerves by restricting or preventing movement so as to prevent or limit further damage to that area.
  • Inability to straighten to the upright posture after flexing or bending the spine.
  • Locking or freezing in an abnormal posture due to uncontrollable muscle spasm that provokes a defensive posture that prevents any movement.

Treatment of  facet joint arthropathy – Early or acute stage

  • Rest in a position of greatest relief, usually in a non-weight bearing posture for no more than two days, after which movement and gentle activities are reinstituted.
  • Cold therapy or hot packs, whichever offers greatest relief, applied for no more than 20 minutes, followed by at least a 40 minute rest period in which no cold or heat is applied so tissue temperature can come back to normal.
  • Significant reduction and modification of usual daily activities of patient to facilitate recovery.
  • NSAID medications (aspirin, ibuprofen) taken to reduce pain and inflammation. 

Treatment of facet arthropathy – Later or chronic stage

  • When significant improvement has occurred or two weeks have lapsed, additional therapy should be added Sports massage to ease muscle spasm and remove edema from the area of the spine near the facets.
  • Chiropractic manipulation to reduce joint stiffness and fixation to increase local joint range of motion. Back exercises for core muscles to maintain posture.
  • For cervical facet joint problem, a flexible collar, mechanical cervical traction, or orthopedic neck  pillow can be helpful.
  • For lumbar or low back facet joint problem, a flexible low back support and mechanical low back traction can be helpful.