Facet Joint Arthritis
Facet joints are found throughout your spine. They are small joints in the back of your spine that help to stabilise your spine whilst allowing movement. Facet joint arthritis is when these joints become painful and arthritic following direct wear and tear, inflammation, or injury. This can occur at any level of your spine, but is most common in the cervical spine (neck) or lumbar spine (lower back).
Facet joint arthritis causes back pain with stiffness. This stiffness occurs following any prolonged period of immobility, especially first thing in the morning. The stiffness is due the joints being arthritic and inflamed, and it usually settles on movement. The pain from facet joint arthritis can also extend into your thighs, which may be confused with sciatica. Patients can also experience painful muscle spasms in their lower back.
Physiotherapy, chiropractic treatment, osteopathy. The aim of physical therapy is to improve posture and muscle control. Physical therapy and exercise should be the mainstay of management for facet joint arthritis.
If physical therapy fails to give any improvement over a period of several months, then an injection of steroid and local anaesthetic can often provide you with a pain free window in which you can engage in optimal rehabilitation. These injections are called medial branch blocks. If you have a positive response to medial branch blocks injections (at least 75-80% improvement for 4-6 weeks) then you may be a suitable candidate for facet joint denervation.
If you have a positive but short lasting response to medial branch block injections, then a more permanent solution can be to cauterise the small nerves that take the pain signals away from the facet joint using an ultrasound probe.
This is a treatment of last resort and is only rarely performed on patients with facet joint arthritis. It is only considered in patients that have failed to get lasting benefit from less invasive treatments, and in whom there is no other significant pathology in their lower back.