Facet joint osteoarthritis
 Osteoarthritis (degenerative arthritis) can cause breakdown
of cartilage between the facet joints. When the joints
move, the lack of the cartilage causes pain as well
as loss of motion and stiffness.
The facet joints are located in the back portion (posterior)
of the spine. The joints combine with the disc space
to create a three-joint complex at each vertebral level.
The facet joint consists of two opposing bony surfaces
with cartilage between them and a capsule around it.
The joint also has fluid lubricating the joint.
The combination of the cartilage and the fluid allows
the joint to move with little friction. However, facet
joint arthritis causes the cartilage to breakdown and
the joint movement is associated with more friction.
The patient loses motion and as they get stiffer they
have more back pain.
Typically, the low back pain is most pronounced first
thing in the morning. Throughout the day, normal movement
causes fluid to build up in the joint and it becomes
better lubricated, which decreases the pain. Later in
the day the pain typically becomes worse again as more
stress is applied across the joint.
Treatment options
Conservative treatments that concentrate on maintaining
motion in the back are most effective for relieving
the pain.
-
Stretching exercises for the hamstring muscles,
hip joints, and the back can usually serve to prevent
the pain from getting worse.
-
For more severe pain, chiropractic or osteopathic
manipulations can help relieve pain.
-
Water therapy can be also be helpful since
the joints are unweighted in the water and do not
generate as much pain when being moved.
-
Acetaminophen is an effective and relatively
safe non-prescription medication to help alleviate
the pain, and some patients find NSAID's to
be helpful.
The only effective surgical treatment option is a fusion
to stop the motion at the painful joint, but this surgery
is generally not recommended since multiple vertebral
levels tend to be affected by osteoarthritis and multilevel
fusions are generally not advisable.
By:
Peter F. Ullrich, Jr., MD
September 8, 1999
Updated March 15, 2001
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