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Facet DiseaseA degenerative tale

Facet Disease – Anatomical Components

Facet Joint 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 region

Video: https://treatingpain.com/condition/facet-syndrome

Facet Disease – Who does it affect?

Each person’s spinal discs undergo degenerative changes as they age, but not all people will experience symptoms as a result of these changes. Symptoms are most commonly seen in 30 to 50 year olds.

More common in people Extreme Overweight Overuse due to sport or heavy labor Family history of Facet disease Presence of disease such as gout (kind of arthritis causing an attack of sudden

burning pain), other types of arthritis, or infections Damage stemming from injuries like whiplash, and/or sleeping with a twisted neck Sudden jerk of the neck, twisting while lifting overhead, or trauma to the spine

Facet Disease – What is happening Anatomically?

The joint surfaces are lined with cartilage allowing them to glide easily over each other. As we age, the cartilage gradually wears away, and in many cases, growths called “bone spurs” can develop.

When a joint is damaged through normal deterioration, injury, or repetitive trauma, it may become swollen, painful, and stiff. Inflammation is usually temporary, but in arthritic joints, it may cause long-lasting or permanent disability.

Facet Disease – What is happening Anatomically?

Abnormal bony growths, called osteophytes or bone spurs, develop on the vertebrae

Bone spurs growing from the facet joints and rubbing against the nerves of the transverse foramen.

Facet Disease – What happens biomechanically?

Friction between the bones leads to the tenderness, swelling, stiffness, and pain of arthritis.

Osteoarthritis or degeneration of a facet joint The degradation and ware on the cartilage

between the facet joints causes the osteoarthritis

Facet Disease – Non-Surgical Treatments

Rest, Ice, heat, Physical Therapy Good posture Anti inflammatory medication Facet Joint Blocks – To Diagnose and

to treat. A cervical, thoracic or lumbar facet joint injection involves injecting a small amount of local anesthetic (numbing agent) and/or steroid medication, which can anesthetize the facet joints and block the pain

Facet Disease – Surgical Solutions

Facet rhizotomy - In this injection procedure a needle with a probe is inserted just outside the joint. The probe is then heated with radio waves and applied to the sensory nerve to the joint in order to disable the nerve. Theoretically, by deadening the sensory nerve to the facet joint, a facet rhizotomy effectively prevents the pain signals from getting to the brain. A facet rhizotomy injection is successful in providing lasting pain relief for approximately 50% of patients.

Facet Disease – Surgical Solutions

Fusion - In unusually severe and persistent problems, degeneration of the adjoining disc is nearly always present so the segment may require a bone fusion surgery to stop both the associated disc and facet joint problems. Such surgery may be considered radical, but an untreated persistent, episodic, severely disabling back pain problem can easily ruin the active life of a patient and surgery can therefore be a reasonable choice in selected cases.

Facet Disease – Surgical Solutions

Facetectomy and foraminotomy - Lumbar foraminotomy is a surgical procedure that increases the space around the neural foramen and relieves compression of the spinal nerves by removing the disc fragments, overgrown ligaments and bone spurs from the neural foramen.  Sometimes lumbar foraminotomy is not sufficient to decompress the nerves and one or more complete facet joints are also removed, known as facetectomy. Removal of the facet joints destabilizes the spine, necessitating a spinal fusion following a facetectomy.

Facet Disease – Surgical Solutions

Facet Fixation 1.) Removal of lamina 2.) Clamp Facets for

Drill

Facet Disease – Surgical Solutions

Facet Fixation 3.) Drill 4.) Screw

Facet Disease – Case Study

The patient is a 57 year old male with a pastmedical history significant for type 2diabetes mellitus left shoulder and neck pain after a trial of analgesics and muscle relaxants did notimprove his symptoms

Image shows bony destruction at the left C5-C6 facet joint with extension into both the epidural space and bilateral paraspinal soft tissues

Facet Disease – Case Study

Facet joint septic arthritis with extension of the infection into the paraspinal musculature

Facet Disease Case Study

Septic arthritis is most commonly secondary to a bacterial infection with less common, more indolent infections resulting from fungal or mycobacterial causes

He was started on IV Vancomycin and Ceftriaxone, and was on the medication for 6 weeks.

On the 6 month check up, there was no evidence of infection