Description of facet disease
Facet joints are the structures that connect the spinal vertebrae to each other. A facet joint is like many other joints in the body – it has a cartilage lining that allows the bones to glide smoothly over each other and is surrounded by a protective capsule. The function of a facet joint is to provide stability, mobility and support to the spine. Each vertebra has two facet joints, one on each side.
Facet disease occurs when a facet joint degenerates. While this can take place at any level of the spine, it most commonly affects the lumbar (lower spine) region.Some of the terms commonly used to in the diagnosis of facet problems include:
- Facet arthritis
- Facet joint syndrome
- Facet disease
- Facet hypertrophy
- Degenerative facet joints
These terms all refer to essentially the same thing – osteoarthritis or degeneration of a facet joint.
Causes of facet disease
Facet disease may arise when the cartilage in a facet joint is worn down as a result of aging, injury or wear and tear. This type of spinal damage can be attributed to arthritis, work, overuse or an injury sustained in an accident. Another possible result of facet disease is spondylolisthesis, which occurs when a vertebra slips forward in relation to an adjacent vertebra, usually in the lumbar spine.
Symptoms of facet disease
Symptoms related to facet joint problems are usually localized to the area of the affected joint and are often experienced in the cervical (neck), thoracic (mid-back) and lumbar (lower back) regions.
When facets in the lumbar region are affected, a patient may experience lower back pain that radiates to the buttocks and upper thigh area. If facets in the cervical area are affected, pain may occur in the back of the neck and radiate to the top of the shoulders or around the neck.
Treatment of facet disease
Since there are many causes of neck and back pain, it is important to obtain a proper diagnosis. Facet disease diagnosis is relatively easy to accomplish with a thorough physical exam or a diagnostic facet injection (a numbing medication injected into the facet joint). If the source of the pain is the facet joint, then the pain should resolve immediately after the injection. If the pain persists after an injection, it may be caused by spinal stenosis or a herniated/bulging disc, which require different treatments to address.
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If an injection doesn’t effectively relieve the pain, the next step could be a laser facet thermal ablation, which is performed through a small tube (approximately the size of a straw). The laser, fiber optics and irrigation apparatus are placed in the tube to facilitate surgery on the facet joint. The surgeon will use the laser to debride (clean) the joint and deaden the local joint nerve, similar to a root canal procedure performed by an endodontist on a tooth. Laser facet thermal ablation takes less than an hour to complete and will effectively resolve the pain associated with the facet joint.