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Spondylosis (Spinal Arthritis) and Facet Joint Syndrome

 

 

At each level in our spine, there is a single disc separating the bones (vertebrae) in front of the spinal canal, and a pair of joints called facet joints joining the bones together behind the spinal canal. As we age, the spinal discs and facet joints can wear out and degenerate. Disc degeneration is the terrm used to describe the wearing out of the discs. Spondylosis is the term used to describe degeneration and arthritis of the facet joints. Degeneration of the spine is a normal aging process, and in most cases spinal arthritis does not cause significant symptoms. However, for some people, arthritic facet joints can cause significant pain. Back or neck pain resulting from arthritic or inflamed facet joints is a condition called “facet joint syndrome”.

Symptoms

  • Back pain with radiation into hips and buttocks or neck pain with radiation into the shoulders

Natural History (“Doing Nothing”)

  • Not all arthritic facet joints cause symptoms
  • Back or neck pain may not be coming from the facet joints even if they are arthritic
  • Symptoms may resolve without treatment
  • Symptoms may be short-lived and infrequent
  • Rarely, patients develop more persistent and debilitating pain
  • Facet joints have very little ability to repair themselves or regenerate

Three Phases of Treatment:

  • Phase I – Non-Invasive Treatments
  • Phase II – Spinal Injections
  • Phase III – Surgery (rare for this condition unless radiculopathy is present)
  • Goals of Each Phase:
    • Relieve Pain
    • Improve Function

Treatment Options: Phase I – Non-Invasive Treatments

  • Physical Therapy and Regular Home Exercise
    • Neck or Back Strengthening
    • Flexibility and Stretching
  • Oral Medications
    • Steroids
    • Non-Steroid Anti-Inflammatories (NSAIDs)
    • Pain relievers
    • Muscle Relaxants
  • Ice and Heat
  • 4-6 weeks of Phase I treatment before MRI and going to Phase II

Treatment Options: Phase II – Facet Joint Injections and Facet Joint Nerve Ablation (RFNA)

  • Facet Joint Injections
    • Outpatient procedure
    • Done with x-ray guidance
    • Steroid is injected into the inflamed joint to reduce pain
    • May relieve symptoms, but will not reverse the joint arthritis
    • Successful injection may help confirm that pain is coming from the facet joints

Facet Joint Rhizotomy (Nerve Ablation) (Radiofrequency Nerve Ablation – RFNA)

  • The word rhizotomy means “nerve destruction” or nerve ablation. In facet rhizotomy, the tiny nerve fibers that carry pain signals from the facet joints to the brain are selectively destroyed using some form of energy.
  • For patients who have had successful, but temporary relief of their back or neck pain from the facet injections, facet rhizotomy may provide more long-term relief.
  • Facet rhizotomy is most commonly performed using a form of energy called radiofrequency (RF) energy. When done with RF, this technique is often called 

Treatment Options: Phase III – Surgery

  • Rarely needed for Spondylosis or Facet Joint Syndrome unless radiculopathy or stenosis is present
    • Back and neck pain from Spondylosis can be treated non-surgically in most cases