Spinal Arthritis (Facet Arthropathy): Overview

Spinal Arthritis (Facet Arthropathy): Overview

This video provides an overview of spinal arthritis, also called facet arthropathy. Arthritis is an umbrella term that refers to the inflammation of joints. Arthritis can happen in a variety of ways, such as autoimmune conditions, injuries, lifestyle factors, and wear and tear over time. The wear and tear type is called osteoarthritis, which results from the breakdown of the smooth cartilage that lines the joint surfaces. Osteoarthritis is well known for affecting the knees and hips, but it can also affect the small facet joints of the spine.

What are the facet joints? First, let us take a look at the entire spine. The spine is made of 33 bone segments called vertebrae that are in 3 major sections the cervical, or neck; the thoracic, or mid-back; and the lumbar, or low back. Throughout the spine, the bony components of the vertebrae change to support different functions, such as protecting the spinal cord or blood vessels, or forming joints with the ribs. While each vertebra may look different, they all have components called articular processes that extend upward and downward. These processes are lined with articular cartilage and connect with the vertebrae above and below. These are the facet joints.

These facet joints connect the vertebrae in a chain like formation all the way down the spine, supporting all motions like bending and twisting. Additionally, discs made of cartilage lie between each vertebra to act as cushions and shock absorbers as the spine moves. Lastly, the spinal cord runs through the middle of the spine, with nerves exiting from the sides of the vertebrae. One important type of nerve that exits at each level of the spine is the medial branch nerve. These nerves pick up sensory information like pain and send it to the brain.

What is facet arthropathy? Facet arthropathy is arthritis of the facet joints. As the cartilage of the facet joint wears down, the joints can become stiff and painful, sometimes resulting in excess bone growth.

How does facet arthropathy develop? The natural aging process can cause the cartilage of the facet joints to wear down. Decreased cartilage may increase the stress on the facet joints and inflammation may worsen over time. Facet arthropathy may occur by itself, but it may happen alongside another common aging process called degenerative disc disease. Here, the normal height of the intervertebral disc decreases, so the ability to absorb shock also decreases. As a result, more stress is placed on the facet joints. It is unknown which condition comes first, but facet arthropathy and degenerative disc disease create a cycle that makes each other worse over time.

Facet arthropathy is one of the most common degenerative conditions affecting the spine, and the likelihood of being affected steadily increases with age. Arthropathy of the cervical spine may be present in 19% of 45-64 year olds, increasing to 57% for ages 65 and older. For the lumbar spine, arthropathy increases to 67% of 45-64 year olds and almost 90% for ages 65 and older. Lumbar arthropathy is more likely to occur in women. The most common vertebrae affected are L4 and L5. Other risk factors include obesity, prior injury, or genetic abnormalities.

Signs and symptoms. Many patients may have facet arthropathy without any symptoms, but some patients may experience the following. Pain localized at the site of arthritis. This may feel like neck or lower back pain. Stiffness or limited range of motion that may be accompanied by grinding or clicking. Increased pain with certain movements potentially limiting the ability to do daily activities. In some cases, the joint space gets smaller and excess bone grows, which may compress the nearby nerves. This can cause radiating pain down the arms or legs.

Exam and diagnosis. When a patient presents to a health care professional with any of these symptoms, a variety of methods will be used to make the diagnosis. The healthcare professional will carefully perform a physical exam feeling and assessing for pain or limitations with motion, as well as grinding or clicking. Compression may be applied with certain movements to try to locate the area of arthritis and determine if any nerves are involved. Imaging will be used to view the spine. X-rays and CT scans view the bony anatomy, while MRI views the intervertebral discs and surrounding soft tissue. Furthermore, a physician may use a diagnostic injection to confirm the location of the pain source. These methods will support the diagnosis of facet arthropathy,