Facet
Joint Syndrome
Definition:
The facet joints are paired joints located on the posterior aspect of
the spine at each level. The joints provide stability to the spine and
limit excess motion. Each facet joint is lined with cartilage and
surrounded by a lubricating capsule that enables the vertebrae to move
freely. These joints have nerve endings both inside and outside the
joints. Causes of irritation and stress to the facet joints include:
misalignment, everyday wear and tear, trauma such as motor vehicle
accidents, previous back or neck injuries and intervertebral disc
degeneration. As with other joints they can undergo degeneration or
arthritic changes.
Symptoms:
Facet joints can present with a variety of symptoms depending on the
location of the irritated joints. Local tenderness in the region over
the joint is common. In the neck (cervical spine) pain can be present in
the neck, shoulders, upper and mid back. Headaches are also possible. In
the low back (lumbar spine) pain is often felt in the low back, buttocks
and backs of the thigh/s. The pain is often made worse by bending
backward or rotating. A protective reflex arises when facet joints are
inflamed which cause the nearby muscles of the spine to go into spasm.
This may lead to a limitation in muscular flexibility called guarding.
Treatment Options:
Various treatment options are available for facet joint pain. In
general, successful long-term treatment involves proper exercise, with
instruction provided by a physical therapist or other health care
provider trained in spine-care. Maintaining good posture is particularly
important as is learning to modify ones activities to avoid further
damage and alleviate pain. Anti-inflammatory medications also called
NSAIDS such as ibuprofen and naproxen can be helpful. Manipulation can
also be used to realign joints and provide pain relief. For persistent
pain, X-ray guided injections can be performed to place medication
directly into the joints at the source of the pain. Finally, destruction
of the small nerves to the joint can be performed by trained physicians
with an electrified heat probe. If successful this can provide relief
for up to six months.
Prognosis: Fortunately,
the vast majority of patients respond well to a combination of
medications, lifestyle changes and proper exercise. Education and proper
training in biomechanics are crucial. This can often reduce the pain to
manageable levels. Risk factors for recurrence include poor flexibility
and poor strength of neck, low back, pelvic and shoulder girdle muscles.
As with other musculoskeletal conditions, the exercise should not end
with supervised therapy. It should continue with a home exercise program
in order to maintain an increased level of function and provide lasting
pain relief.
Spinal
Stenosis
Definition:
Spinal stenosis is a narrowing of the spinal canal. This may be caused
by several different conditions. Some people are born with a canal
narrowing (congenital stenosis). Other common causes include disc
bulging or herniation as well as arthritic changes which cause
bony-build-up of the joints of the spine. Many of these degenerative
changes are the consequence of normal aging. When there is narrowing of
the central spinal canal as well as the tunnels where the nerves exit
the canal, nerve tissue can become irritated.
Symptoms:
Spinal stenosis can present with localized neck or back pain but because
of irritation to nerve tissue, there is often associated pain in the
arms or legs. Numbness and tingling may also be present in the affected
limbs. The back or leg symptoms may be worsened with standing and
walking and relived with leaning forward or sitting. Symptoms in the
neck and arms may be worsened with tilting the head backward.
Treatment Options:
Many treatments are available for spinal stenosis, perhaps the most
important of which is activity modification. Education is also crucial.
Successful long-term treatment involves proper exercise, with
instruction provided by a physical therapist or other health care
provider trained in spine-care. Instruction in modification of posture
and activities is helpful to avoid further irritation and alleviate
pain. The pain present in spinal stenosis is thought to have an
inflammatory component, so anti-inflammatory medications are often part
of a treatment program.
Spinal stenosis is a
structural condition which often takes years to develop. It sometimes
requires more aggressive treatment to control symptoms. For persistent
pain, epidural injections are often used. These x-ray guided injections
place medication directly into the spinal canal at the source of the
pain. They are effective for many patients. Occasionally. repeat
injections are necessary depending upon each individual's response. When
symptoms are under better control physical therapy is advanced to
improve function.
Prognosis: The
prognosis for patients with spinal stenosis is dependent upon the cause
of the spinal canal narrowing. If a disc bulge or herniation is
responsible for the narrowing, appropriate treatment with physical
therapy, medications and epidural injections can help significantly.
Most patients respond well to this combination. If underlying arthritic
changes are responsible for the narrowing, then pain control is the main
goal. These arthritic changes may progress to some degree. However, with
appropriate exercise and activity modification, most patients are able
remain active with manageable pain.
Risk factors for
recurrence include poor posture as well as limited flexibility and
strength of neck, low back, pelvic and shoulder girdle muscles. As with
other musculoskeletal conditions, the exercise should not end with
supervised therapy. It should continue with a home exercise program in
order to maintain an increased level of function and provide lasting
pain relief.
Surgical Options:
Surgery is only considered if patients have had limited response to the
above mentioned treatments. Specific indications for surgery include:
progressive loss of strength or sensation in the arms or legs, loss of
bowel or bladder function or severe, unmanageable pain which limits
one's ability to perform day-to-day activities. If disc herniation is
the underlying cause of the spinal stenosis, surgery can be a viable
option. Surgery is typically less effective for age-related or arthritic
spinal stenosis. It may provide reasonable short-term relief, but
long-term relief is less certain.
