Treatment for Facet Joint Arthritis is aimed at reducing the potentially severe pain associated with osteoarthritis of the facet joints. Left untreated, the pain can lead to recurring and/or constant neck and back pain that can limit the ability to work, exercise and even socialise.
Treatment starts conservatively, with non-surgical options.
Non-surgical Treatment for Facet Joint Arthritis
Adjusting your activities and lifestyle. Repetitive twisting, lifting and extending your lower back often increases pain.
Appropriate exercise. A physical therapist can prescribe appropriate exercises and stretches to improve spinal flexibility and core strength.
Non-Steroidal Anti-inflammatories. These medications can reduce the inflammation caused by degenerating facet joints rubbing against eachother, and thereby reduce pain and increase mobility.
Steroid injections into the facet joints. Cortisone, a powerful anti-inflammatory can be injected directly into the facet joints, providing almost immediate relief. A combination of cortisone and anaesthetic are injected. The anaesthetic provides instant pain relief, and the cortisone takes effect over the following 2-5 days. Pain relief is temporary however, and the pain will usually return after several months.
Radiofrequency Ablation. If steroid injections provide good relief, but the pain relief doesn’t last long enough, a Radiofrequency Ablation or Facet Rhizotomy may be recommended. With this procedure, a needle with an electrical probe is inserted through the skin directly into the nerves that serve the facet joint. The probe is heated with radio waves, which disable the nerve. The procedure does nothing to treat the actual problem (degenerative facet joints) but by deadening the nerve, the patient no longer feels the pain. The long term success rate is about 50%, as the nerves do regenerate and the pain may return over time. The procedure gives more lasting relief than cortisone injections, however, potentially lasting up to 2 years.
Opioid Pain medications. Some doctors will not prescribe opioid medications for fear of addiction, but when taken as directed for chronic pain, that risk is statistically very low. For some, opioid medications can relieve pain and improve function and vastly improve quality of life.
Surgical treatment for Facet Joint Arthritis
Surgery is a last resort, after all conservative and non-surgical treatments have failed, and the patient is still experiencing chronic pain.
In this situation, degeneration and/or herniation of the adjoining disc is almost always a factor, so bone fusion surgery is the recommended option. It is only considered in the most severe cases, where there is daily, severe pain and quality of life is seriously adversely affected.
Lumbar Spinal Fusion Surgery
Lumbar Spinal fusion surgery fuses the two vertebral segments preventing further movement, thereby decreasing the pain generated from the facet joints. With this surgery, the damaged vertebrae are replaced with a bone graft, and the surrounding vertebrae are surgically stabilised.
After surgery, that section of the spine is permanently immobilised.
This is an invasive procedure, that requires months of recovery and rehabilitation to regain strength and mobility. There is also a risk that the patient will continue to experience back pain, even if the operation is a success, and achieves a successful fusion.
The best chance of success is where only one level of vertebrae are fused, as most patients won’t notice any significant change in mobility with only one level fused. Having two levels fused can be an option for some, but more than two levels is unlikely to be successful, as removing too much of the normal mobility of the spine will place too much stress on the remaining joints, which will cause more pain.
The best results are in patients with only one level of fusion required, two at most, and who lead a healthy lifestyle (non-smoker, healthy weight) and who are strongly motivated to take on the necessary rehabilitation and exercise to restore normal, hopefully pain free, function.