Facet syndrome in the cervical (upper) spine

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Claude York
6 years ago
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structural deterioration of one or more of the vertebral facet joints in the cervical segment of the spine, which is located in the neck.

1 Dr. Michael J Walls, MD 320 Thomas More Parkway. Ste 202 Crestview Hills, KY Phone: (859) Facet syndrome in the cervical (upper) spine Cervical facet syndrome, also known as cervical facet disease or cervical osteoarthritis, is the structural deterioration of one or more of the vertebral facet joints in the cervical segment of the spine, which is located in the neck. This type of osteoarthritis is particularly common later in life, and can lead to significant, chronic pain if left untreated. As is the case with most degenerative spine conditions, treatment of cervical facet syndrome is normally first attempted conservatively, with more invasive options considered if pain persists. The facet joint The seven vertebrae in the neck (with the exception of the first cervical vertebra, C1) are connected to adjacent vertebrae at a synovial, fluid-filled encapsulated joint known as a facet joint. This sliding joint s structure stabilizes the spine, but also allows for the movement that we require from our neck. In order to provide this needed flexibility, the joint s articular surfaces are covered by cartilage. This slippery cartilage allows the bones to slide over one another smoothly. Over the years, as a result of regular use and the burden of supporting the weight of the skull, this cartilage gradually wears away, eventually resulting in bone-on-bone contact. Cervical facet syndrome is a term used to describe this condition.

Symptoms of cervical facet syndrome: This condition can cause a number of symptoms, depending on the location and severity of the joint deterioration.

2 Symptoms of cervical facet syndrome: This condition can cause a number of symptoms, depending on the location and severity of the joint deterioration. Examples of symptoms include: Local pain at the site of the joint Soreness or stiffness in the neck Limited mobility Headaches Depending on the location of the arthritic joint, pain may be referred to an number of areas along the back of the head, neck, shoulders, and shoulder blades. In addition to experiencing these issues, people with facet syndrome may also encounter problems due to bone spur growth. As the cartilage that typically cushions bones wears away, the body attempts to restabilize the joint with bony growths known as osteophytes, or bone spurs. These small projections can occur anywhere joint deterioration takes place, and often develop without producing symptoms. However, when bone spurs occur in the spine, there is a possibility that they will interfere with neighboring spinal components. The vertebrae have small spaces through which the spinal cord and nerve roots are able to pass, with very little extra room. When these spaces are narrowed by the development of bone spurs, the projections may place pressure on the spinal cord or nerve roots, thereby disrupting their normal functions. Treatment of cervical facet syndrome Treatment of cervical facet syndrome is most often first attempted conservatively with nonsurgical techniques. This course of treatment is intended to manage the patient s pain and increase mobility in the joint. A course of conservative treatments may include any or all of the following commonly recommended approaches: Pain medications Over-the-counter pain relievers like acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help patients manage the symptoms of facet syndrome. Prescription drugs may be recommended in cases of severe symptoms that don t respond to other medications. Physical therapy Keeping the spine limber and making the muscles surrounding it as strong as possible may help control symptoms. Physical therapy sessions and regular activity can maintain or improve flexibility and muscle tone. Application of heat or ice Applying a heating pad at the site of the pain may temporarily address the discomfort, and placing an ice pack on a sore or swollen area can help reduce inflammation. Physicians often recommend one or both of these methods, and it s important to follow instructions about how to apply the source of heat and/or cold.

Facet joint injections Using a combination of a numbing medication and an antiinflammatory steroid, physicians can perform injections at the site of joint deterioration to reduce pain.

3 Facet joint injections Using a combination of a numbing medication and an antiinflammatory steroid, physicians can perform injections at the site of joint deterioration to reduce pain. Also, because it can be difficult to pinpoint the exact source of symptoms, injections at multiple facet joints can help physicians locate the joint causing pain and make more accurate diagnoses. Cervical Facet Radiofrequency Ablation: How is a diagnosis made? Facet pain can be similar to other spine conditions. An accurate diagnosis is important to determine whether the facet joint is the source of your pain. Evaluation includes a medical history and physical exam. The doctor will consider all the information provided, including any history of injury, location of your pain, and problems standing or sleeping. You may be asked to stand or move in different positions and point to where you feel pain. The doctor may manipulate your joints or feel for tenderness over the spine. Imaging studies, such as X-ray, CT, or MRI, may be ordered to help in the diagnosis and to check for other spine and hip related problems. Typical pain referral patterns for neck and low back can be seen below:

4 Figure 3. A facet joint injection is a minimally invasive procedure that involves an injection of a corticosteroid and an analgesic-numbing agent into the painful joint A diagnostic facet joint injection is often performed to confirm the cause of pain. The facet joint, or the nerve supplying the joint, is injected with a local anesthetic and corticosteroid medication (Fig. 3). The injection is given using X-ray fluoroscopy to ensure accurate needle placement to the affected area. Your pain level is evaluated before the injection and then again in the first hour following the injection. Facet joint involvement is confirmed if your pain level decreases by more than 80% from the initial score the first hour following the injection though you may go on to receive much longer relief. If your pain level does not change after the injection, it is unlikely that the facet joint is the cause of your pain. This injection may be repeated twice for confirmation as appropriate. If steroid joint injections are successful but pain recurs frequently, an ablation procedure to burn the small nerves of the joint capsule may be recommended. First, a diagnostic nerve block test is performed to determine which nerves are to be treated. Anesthetic is injected along the nerve to block pain (Fig. 4). If the block is successful, a radiofrequency ablation will likely provide more lasting pain relief.

5 Figure 5. Once the needle is in place, an electrode is inserted and a radiofrequency current destroys some of the medial branch nerve fibers carrying pain signals in the joint A nerve ablation procedure is performed similar to the nerve blocks. Once the needle is in place, an electrode is inserted and a radiofrequency current destroys some of the medial branch nerve fibers carrying pain signals in the joint (Fig. 5). Pain relief may last from 9 months to more than 2 years. It is possible the nerve will regrow and pain could return in the future necessitating repeat procedure.. Recovery and prevention It is important to remember that injections and radiofrequency ablations may help symptoms, but do not change the underlying degeneration of the spine. Regular stretching, strengthening and weight management along with smoking cessation may slow the degeneration process and reduce stress to the facet joints by improving the overall strength and condition of the back and lowering inflammation in the body. Contact Information If you have more questions, please contact Pain Associates of Northern Kentucky at Links Glossary anesthetic: an agent that causes loss of sensation with or without the loss of consciousness. corticosteroid: a hormone produced by the adrenal gland or synthetically. Regulates salt and water balance and has an anti-inflammatory effect. facet joints: joints located on the top and bottom of each vertebra that connect the vertebrae to each other and permit back motion. joint capsule: a sac surrounding a synovial joint. nerve block injection test: is an injection of anesthetic on or near the nerve/pain receptor connected to a specific nerve or joint. radiofrequency ablation: a procedure that uses a radiofrequency current to deaden the nerves surrounding the facet joint and prevent pain signals from reaching the brain; also called facet rhizotomy or facet neurotomy.

Facet Joint Syndrome / Arthritis

Facet Joint Syndrome / Arthritis Overview Facet joint syndrome is an arthritis-like condition of the spine that can be a significant source of back and neck pain. It is caused by degenerative changes to