Dr. Meier Writes Article on Facet Joint Arthritis

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Dr. Marshall Meier wrote the following article on facet joint arthritis, which was featured in the September 2015 edition of the Flagstaff Business News.

Definition:

Low back pain is the most common pain symptom experienced by American adults and the second leading reason for doctor visits.  Back and neck pain can frequently be attributed to what is referred to as Facet Joint Arthropathy or arthritis, which is a degenerative disease that affects the joints of the spine and the breakdown of cartilage in those joints. Facet joints are small joints which are located on the back of the spine and allow for the spine to bend and twist without allowing the spine to undergo excessive slipping. These joints have cartilage which is a smooth tissue that covers the end of bones and allows for smooth movement where the two bones meet.  Just like any other joint, this cartilage can wear out or suffer trauma, which can cause pain and overall decreased function.    

Causes:

Facet joint arthritis can be caused by wear and tear on a joint as we age  or can  be related to an acute traumatic event or abnormal postures.  These conditions can cause an overload of these joints leading to inflammation and pain. 

Symptoms:

Facet pain does not follow a typical nerve pattern but is rather a generalized poorly defined pain in the region of the back or the neck.  These joints may also cause what is known as referred pain.  Because of this referred pain, neck facet arthritis may cause pain that radiates over the top of the head, into the shoulder region or even into the upper back.  Low back facet pain may cause pain into the buttock region and back of the upper thighs.  Symptoms commonly tend to be worse first thing in the morning or after prolonged sitting or standing. 

Diagnosis:

Diagnosis of facet joint pain is first evaluated by physical exam.  During the exam, tenderness to palpation over the joints or paraspinal muscles is a common finding. The patient may also experience pain with an exam maneuver called facet loading which is a back extension and twisting motion performed during the physical exam.  X-rays or more advanced imaging which can include MRI or CT scans may be useful in assessing for arthritis as well as ruling out other causes of the pain.  However, the most definitive diagnosis is determined through injections which block the nerves that innervate the facet joint itself. Relief of the pain symptoms post injection can help confirm the diagnosis of facet arthritis.   

Treatment:

Initial treatment for facet arthritis is with physical therapy, anti-inflammatory medications, and diet and exercise. If the symptoms do not improve following conservative treatments and after a successful nerve block, a procedure referred to as a radiofrequency ablation may be necessary.  The goal of the radiofrequency ablation (commonly referred to as RFA) is to provide longer relief for the patient.  This procedure is performed very similar to the previously mentioned facet nerve blocks.  Both procedures are performed under x-ray guidance to ensure proper placement of the electrodes.  Once the placement is confirmed with stimulation testing, a medication is applied to prevent any discomfort during the procedure.  When successful, a patient can expect anywhere from 6-18 months of improved symptoms.  When symptoms do not improve with conservative or interventional techniques the patient may require a consultation with a spine surgeon.

Conclusion:

Arthropathy or arthritis of the spine is a very common cause of neck and low back pain and decreased function. This condition may be caused by deterioration of the joint as we age or by a traumatic event.  Because of the complicated nature of this condition, multiple treatment options may be necessary in order to help improve the symptoms.  The goal with treatment, as in any pain condition, is to help improve overall function and pain. 

Dr. Marshall Meier specializes in spine care at Flagstaff Bone and Joint located at 77 W Forest Ave. (in the Physicians & Surgeons Offices attached to Flagstaff Medical Center).  Dr. Meier is a physical medicine and rehabilitation specialist with fellowship training in interventional spine.  He offers minimally invasive techniques to relieve or reduce pain.  For additional information or to schedule an appointment visit www.flagstaffboneandjoint.com or call 928.773.2280.