Spinal Arthritis: Why Your Back Hurts

Spinal Arthritis: Why Your Back Hurts

Hi, I am Eric Johnson. I am a physician assistant, and today we will be discussing facet arthropathy and why your back hurts. Let us first start by discussing some of the anatomical features of the spine. The spine runs all the way from the base of the skull to the pelvis, and it is the neural highway for the brain to speak to the rest of the body. It is broken down into several distinct sections: the cervical spine, or the neck; the thoracic spine, or the mid-back; the lumbar spine, or the low back; and the sacrum and coccyx in the pelvis.

Regardless of the section of the spine that we are discussing, the spine is comprised of individual subunits called vertebrae that are stacked one on top of another and in the cervical, thoracic, and lumbar spine are separated by soft and squishy intervertebral discs. Within each individual vertebrae, there are numerous individual anatomical parts or components, and those parts and components can actually vary between one level of the spine and another. For example, in the cervical spine, the vertebrae anatomy is actually slightly different than the anatomy in the lumbar spine. For now, we will focus on the lumbar spine or the low back.

When we look at a side view of the spine, like we see here on the left, we can see a number of different anatomical structures including the vertebral body, the intervertebral disc, and the spinous processes, among others. When we look from a posterior view of the spine or a view from the back of the spine like we see in the image on the right, we can see many of the same structures, but we can also see more clearly the transverse processes and the facet joints.

For now, let us just focus on the facet joints. What are these facet joints? These facet joints are found at every level of the spine from the cervical spine all the way down to the lumbar spine. They are found on both sides of the spine and allow for movement in all planes. They allow for flexion, extension, and rotation of the spine and also play a role in stability. These are also articular joints, so similar to other articular joints in the body such as the knee, they contain articular cartilage and as such may develop arthropathy, or arthritis.

What is arthropathy of the facet joints? Any time you have a joint with articular cartilage, you can develop arthropathy, or arthritis, of that joint, which is simply a degeneration of the cartilage within that joint. In the setting of facet arthropathy, we know that this is a relatively common cause of both low back and neck pain. This is often linked to aging or normal wear and tear of the joints, and can potentially be related to changes within the intervertebral discs as well.

Let us consider a patient with facet arthropathy. These patients will typically experience symptoms such as localized back or neck pain. They can also have stiffness as well. These symptoms are often made worse or exacerbated by movement, particularly with rotation and extension of the spine. Occasionally, facet related pain may also radiate to the hips, thighs, or shoulders.

However, it is important to note that this pain differs from the radiating pain that you can get that is associated with other spinal pathologies that can typically radiate all the way down to the lower legs or lower arms. As we have alluded to, a common cause of facet arthropathy is just general aging and wear and tear of the joints. However, patients with previous spinal injuries, such as a fracture or spinal trauma, may also be predisposed to developing arthritis as well. Furthermore, if a patient has a known history of disc degeneration, this can also put increased stress and strain on the facet joints and cause them to deteriorate and develop arthropathy or arthritis over time.

When we consider diagnosis of a patient with facet arthropathy, this involves a thorough patient history and physical exam. Oftentimes, the diagnosis of facet arthropathy is suspected based on history and physical exam alone. Advanced imaging such as x-ray, MRI, or CT scans can also help with diagnosis of arthropathy of the facets by showing signs of degeneration of the facet joints themselves. Lastly, when treating spine pathology, we really want to make sure that we are treating the correct pathology. In some instances, we will actually use diagnostic injections such as a medial branch block to accurately diagnose whether or not a patient's pain is coming from the facet joints.

Once a patient has been diagnosed with facet arthropathy or arthritis, they have many treatment options available. We typically begin with more conservative treatments like physical therapy and exercise, which can help significantly with both pain and function of the joint. Our typical anti-inflammatory medications, such as ibuprofen or Tylenol, may also help alleviate pain.

Beyond oral medications and therapeutic exercises, we also have more invasive treatment options, such as injections into or around the facet joints. For certain patients, surgical intervention may also be warranted. In the case of isolated facet arthropathy, many patients may also be candidates for a medial branch nerve transection, which is a procedure in which a surgeon is able to visualize and transect or cut the nerve that supplies sensation to the facet joint, which can help alleviate facet-related pain.

Beyond initial treatment, what does self-care and prognosis look like for someone with facet arthropathy? Well, the good news is that most patients do very well and improve significantly with conservative treatment options alone. As with many things in orthopedics, it is best practice to stay active and maintain a healthy body weight, but for patients with new or worsening symptoms, seeking advice from your medical provider is advised.

In summary, facet arthropathy is a common and manageable degenerative condition that may affect the neck or low back. Always advise to see a clinician if a patient is experiencing new neck or back pain, especially if it radiates to the upper or lower extremities. Nonetheless, there are plenty of conservative nonoperative treatment options available, and for those who require it, there are minimally invasive surgical options available as well to treat facet-related pain. Thank you for tuning in to OrthoPedia.