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What is Facet Joint Arthritis?

Facet joint arthritis is a very common cause of low back and neck pain in adults.  It is a condition in which the small joints, called facets, in the back of the spine become arthritic and painful, similar to the way arthritis in the knee or hip is painful. Facet joint arthritis is also known as facet arthropathy or spondylosis.

What are Facet Joints?

Facet joints connect the vertebral bodies, or bones, in the spine to one another and help keep the spine stable with normal movement. Facet joints are lined with cartilage, contain a small amount of joint fluid, and are encased in a joint capsule. There is a pair of facet joints at each level, and they are named for the vertebral bodies they connect. For example, the L4/5 facet joints connect the lumbar 4 and lumbar 5 vertebral bodies.

How does Facet Joint Arthritis develop?

Each facet joint is lined with cartilage, and over time the cartilage may thin and wear out. As a result, the joint will become inflamed and develop bone spurs, enlarging the joint.  This is also called facet joint hypertrophy. These changes can be due to a variety of factors, but typically anything that puts greater strain on the facet joint over time, such as manual labor, obesity, lack of exercise and deconditioning, will lead to degenerative changes in the joint. Genetic factors may also play a role even in the absence of these factors.

Where does Facet Joint Arthritis occur?

Facet joint arthritis commonly occurs in the low back or lumbar spine. It also occurs in the neck, or cervical spine, and to a lesser extent in the upper back, or thoracic spine. The lower lumbar facet joints, such as L3/4, L4/5, and L5/S1, are the most common location of facet arthritis because they carry the greatest weight compared to other areas of the spine.

What are the symptoms of Facet Joint Arthritis?

In the lumbar spine, the symptoms are typically lower back pain, which may be accompanied by radiation of the pain to the buttocks or the back of the thighs. In the cervical spine, the symptoms are typically neck pain, which may be accompanied by radiation to the shoulders, upper back or to the back of the head. Leaning back and rotating the spine typically worsens the pain. Decreased spinal flexibility and muscle spasm frequently accompany the pain.

How do you diagnose Facet Joint Arthritis?

A proper history and physical exam may suggest facet arthritis. X-ray, CT scan or MRI may confirm the presence of arthritis; however, facet joint arthritis is just one potential cause of low back or neck pain. If interventional treatments are planned, diagnostic injections with local anesthetic are required to confirm that the source of the pain is the facets.

What are the initial treatment options for Facet Joint Arthritis pain?

Anti-inflammatory pain medications, muscle relaxers or other pain medications, activity modification, weight loss, physical therapy, and regular exercise all may be helpful at reducing pain.

What are the options if conservative treatments fail?

Because back and neck pain may have multiple causes, first one must confirm that the facet joints are the source of pain. To determine if the facet joints are causing pain, a diagnostic injection of local anesthetic can be performed, either into the facet joint, or around the nerves that sense pain in the facet joint. These nerves are called the medial branch nerves. If pain is reduced by this diagnostic injection, then a procedure called a rhizotomy is performed. A rhizotomy uses radiofrequency energy to heat the facet joint nerves so that they can no longer sense pain. In cases where an enlarged arthritic facet joint is causing nerve compression or spinal stenosis, referral to a spine surgeon may be indicated.

How do you keep Facet Joint Arthritis pain from returning?

Intermittent flare-ups are common with chronic back and neck pain. The best long-term pain management strategy consists of regularly participating in exercises that restore spine health and stability. With the assistance of a Physical Therapist, participating in a home exercise program that focuses on increasing strength, endurance and flexibility will be the best defense against chronic pain.

 

Cyndi: I’m sure many of you out there feel pain every single day, but just because you do, it doesn’t mean you can’t have it fixed. Even when it comes to a joint that often hurts, your knees, your hips, you name it. Dr. Rudy Gari from Florida Pain Relief Group joins us now to tell us what can be done about it. Dr. Gari, I think a lot of people at home are going, “That’s me, I’m half pain. When I bend down and do a knee bend, I can hear my knees. Is that normal?

Dr. Gari: No, it’s not normal. It’s something that’s called crepitus.

Cyndi: Crepitus?

Dr. Gari: Crepitus. And crepitus means that you have an inflammatory process, some sort of inflammation going on in those joints. It’s not a normal process. We have to examine and see what’s going on with it.

Cyndi: Can you help?

Dr. Gari: Yeah, absolutely.

Cyndi: Okay, good.

Dr. Gari: Yes, we can.

Cyndi: What about people who get symptoms of aches in their joints when there’s a weather system happening? What is happening there?

Dr. Gari: Well, what’s going on is that, I like to say that my patients are the best weather forecasters because they will tell me when it’s about to rain. Because they can actually sense, their pain increases, because the change in the atmospheric pressure affects the joint pressure that you have. We can sense that. So you know, normally we don’t, but if you have an inflammatory process in your joints anywhere, that becomes magnified significantly when the atmospheric pressure changes. So, humidity and a lot of that really tends to affect people that are in chronic pain a lot.

Cyndi: And you have some really innovative ways to help people with this inflammation, right?

Dr. Gari: Absolutely. What we do is, we first determine what’s going on, what’s causing that inflammation. We wanna get to the root of the problem. You know, what can we do? Sometimes it’s just arthritis, sometimes there may be some sort of a mass that can be removed, sometimes it’s trauma. But most of the times, almost always, it’s some sort of inflammatory process that’s causing that. And we get to that whether it’s through medication, through a pill, through an ointment, through a cream. Sometimes just a simple injection into the joint gets rid of it. Sometimes the joint in and of itself is so arthritic that we have to try to redevelop that joint. And one of the things that we perform as well is called regenerative medicine, where we can actually put stem cells, allografts, very innovative things, that can actually redevelop some of those tissues that you have in your joints.

Cyndi: That’s great. So it’s not necessarily a life sentence, it’s something that can be treated.

Dr. Gari: There’s a lot of exciting things that’s going on in medicine today, and it’s very exciting, what we can do.

Cyndi: What about for people who wake up in the morning with pain and stiffness in their joints, is there anything you can do for that or is it just a matter of getting up and stretching? Or is there more to it than that?

Dr. Gari: Well, the reason why you have joint pains in the morning is because your temperature drops. So when your temperature drops during sleep, and that also causes your joints and so forth to become a lot more stiff. So, when you get up, take a hot shower and so forth, that really increases, and you get less stiff and you have a lot less pain.

Cyndi: What about for people who have nagging, reoccurring pain? Is surgery ever the answer, or not?

Dr. Gari: Well, usually, the answer is no, but sometimes there might be something going on where you need an operation. But most of the times, you don’t need an operation. Most of the times, it could be something like physical therapy, a pill or medication, sometimes a little simple injection. Sometimes, there’s something that’s called the hydraulic membrane which, it’s like a lubrication into your knees that we can inject into your joints that can last several months. Sometimes there’s stem cells, there’s all kinds of different options.

Cyndi: Well, that’s good to hear because I know a lot of people would rather try every option before they have to go under the knife. Dr. Gari, thank you very much. You can contact the Florida Pain Relief Group to schedule your same-day appointment. We’ll be back with more “Daytime,” so don’t go away.

 

Interviewer: People who are in pain oftentimes don’t go to the doctor because they fear the worst. We all sometimes feel like that, right? But some pain can actually be treated without surgery. Dr. Rudy Gari from Florida Pain Relief Group is back to tell us more. And good to see you, doctor.

Dr. Gari: Good seeing you.

Interviewer: And specifically, we’re talking about something called a rhizotomy. Now, what is a rhizotomy and what does it do?

Dr. Gari: Certainly. So a rhizotomy, basically, what we’re doing is we’re finding ways to deaden the nerves in a permanent way. There are tiny little nerves that give sensation to your joints, and they’re just purely sensory nerve. They don’t do anything else other than just cause you to have pain if you have some sort of inflammatory process, which can happen a lot. So, people, if they have some sort of a chronic inflammatory process through the joints, those nerves are constantly reminding them. What we do is we first make sure that that’s the cause of the pain, and once we’ve diagnosed that, we do something that’s called rhizotomy. And what that does is, we place these needles right into those tiny little nerves. The needle tip heats up and it burns those little nerves off, and that relief can last several months, sometimes up to a year.

Interviewer: So it’s not a permanent relief but it is something that will give you relief for, like you said, a certain amount of time.

Dr. Gari: Yes. Unfortunately, a lot of those tiny little nerves tend to grow back, but I’ve had people who’ve had relief for over a year. And if you have pain on a daily basis, that’s a lifetime.

Interviewer: Yeah, no kidding. And it’s not too much trouble, then, to just come back when the pain flares up again, too?

Dr. Gari: Absolutely. We can repeat this. And the nice thing about it is that this is done through a needle, so we’re not cutting skin, it’s not a permanent operation and it’s a relatively benign procedure. We have a lot of safety measures in check.

Interviewer: So does it hurt at all? You mentioned needle. That’s the first thing I think of, “How much pain is involved to get pain relief?”

Dr. Gari: Yes. No, it’s actually fairly painless. We give a local anesthetic at the skin. We then go ahead and use some intravenous sedatives. And, in fact, just this morning I had four patients that had the rhizotomy done and they went home already.

Interviewer: So what areas does this benefit, primarily? Is it the knee? Is it the shoulder? Can it be any joint?

Dr. Gari: Well, the rhizotomy can occur in just about anywhere. The most common places happens to be at the neck and the lower back. The reason for that, most of the bending takes place at your neck and lower back, so that’s where a lot of the trauma and a lot of the pain comes from.

Interviewer: Now, what makes this kind of a good idea to do as a procedure to relieve the pain, as opposed to other treatments?

Dr. Gari: Well, what happens is, there’s not a whole lot of treatments that are available when you have chronic pain of your joints, for example. It’s usually medications, and those medications have significant side effects. Anti-inflammatories can cause an ulcer, can cause bleeding. You have opioids. We all know about the problems with opiate addiction. So this is an alternative to you having to take medications. Medications are not benign. They’re not mean to be taken on a long-term basis, but people have to take them that way. This is an option so that you don’t have to take these medications long-term.

Interviewer: You know, it’s funny you mentioned that because I know so many people who have their elderly parents actually hooked on opiates, and they don’t even know it. Because that’s what they’re prescribed, that’s what they take. So this is something that’s so much healthier and so much better for you.

Dr. Gari: Absolutely. I had an 81-year-old female today, a very nice lady, that was taking a lot of medications. And the problem with that, if they get a little bit groggy, and they fall and they break a hip, that can be lethal.

Interviewer: Absolutely. All right, Dr. Gari, great information. Now, Florida Pain Relief Group even schedules same-day appointments. Be sure to visit their website, floridapainreliefgroup.com, or give them a call, 844-KICK-PAIN. Simple as that. We’ll be right back.

What is Facet Joint Arthritis?

Facet joint arthritis is a very common cause of low back and neck pain in adults.  It is a condition in which the small joints, called facets, in the back of the spine become arthritic and painful, similar to the way arthritis in the knee or hip is painful. Facet joint arthritis is also known as facet arthropathy or spondylosis.

What are Facet Joints?

Facet joints connect the vertebral bodies, or bones, in the spine to one another and help keep the spine stable with normal movement. Facet joints are lined with cartilage, contain a small amount of joint fluid, and are encased in a joint capsule. There is a pair of facet joints at each level, and they are named for the vertebral bodies they connect. For example, the L4/5 facet joints connect the lumbar 4 and lumbar 5 vertebral bodies.

How does Facet Joint Arthritis develop?

Each facet joint is lined with cartilage, and over time the cartilage may thin and wear out. As a result, the joint will become inflamed and develop bone spurs, enlarging the joint.  This is also called facet joint hypertrophy. These changes can be due to a variety of factors, but typically anything that puts greater strain on the facet joint over time, such as manual labor, obesity, lack of exercise and deconditioning, will lead to degenerative changes in the joint. Genetic factors may also play a role even in the absence of these factors.

Where does Facet Joint Arthritis occur?

Facet joint arthritis commonly occurs in the low back or lumbar spine. It also occurs in the neck, or cervical spine, and to a lesser extent in the upper back, or thoracic spine. The lower lumbar facet joints, such as L3/4, L4/5, and L5/S1, are the most common location of facet arthritis because they carry the greatest weight compared to other areas of the spine.

What are the symptoms of Facet Joint Arthritis?

In the lumbar spine, the symptoms are typically lower back pain, which may be accompanied by radiation of the pain to the buttocks or the back of the thighs. In the cervical spine, the symptoms are typically neck pain, which may be accompanied by radiation to the shoulders, upper back or to the back of the head. Leaning back and rotating the spine typically worsens the pain. Decreased spinal flexibility and muscle spasm frequently accompany the pain.

How do you diagnose Facet Joint Arthritis?

A proper history and physical exam may suggest facet arthritis. X-ray, CT scan or MRI may confirm the presence of arthritis; however, facet joint arthritis is just one potential cause of low back or neck pain. If interventional treatments are planned, diagnostic injections with local anesthetic are required to confirm that the source of the pain is the facets.

What are the initial treatment options for Facet Joint Arthritis pain?

Anti-inflammatory pain medications, muscle relaxers or other pain medications, activity modification, weight loss, physical therapy, and regular exercise all may be helpful at reducing pain.

What are the options if conservative treatments fail?

Because back and neck pain may have multiple causes, first one must confirm that the facet joints are the source of pain. To determine if the facet joints are causing pain, a diagnostic injection of local anesthetic can be performed, either into the facet joint, or around the nerves that sense pain in the facet joint. These nerves are called the medial branch nerves. If pain is reduced by this diagnostic injection, then a procedure called a rhizotomy is performed. A rhizotomy uses radiofrequency energy to heat the facet joint nerves so that they can no longer sense pain. In cases where an enlarged arthritic facet joint is causing nerve compression or spinal stenosis, referral to a spine surgeon may be indicated.

How do you keep Facet Joint Arthritis pain from returning?

Intermittent flare-ups are common with chronic back and neck pain. The best long-term pain management strategy consists of regularly participating in exercises that restore spine health and stability. With the assistance of a Physical Therapist, participating in a home exercise program that focuses on increasing strength, endurance and flexibility will be the best defense against chronic pain.