The articular facet is a vertebral bone structure that has the function of connecting the vertebrae to each other, allowing the flexion and torsion movements of the spine, limiting at the same time its movements beyond a certain limit. The joints have cartilage that allows smooth movement and are wrapped in a synovial membrane with a lubricating liquid inside.
When, as a result of trauma or arthritic phenomena, damage to these joints occurs, pain begins. The mechanism of onset is due to the cartilage damage that causes a “rubbing” between the two bone surfaces, with consequent inflammation; this, in turn, can lead to the formation of bony beaks (osteophytes) that grow on the periphery of the joint and compress the adjacent nerves. The same physiological deterioration of the cartilage, which occurs with advancing age, can irritate the small nerves that innervate the joint capsule, thus contributing to the onset of pain.
The syndrome of the facet joints or Facet Joint Arthropathy can affect the cervical or lumbar spine.
At the cervical level, the syndrome manifests itself with pain in the neck and shoulders, with a limitation of movements in flexion and twisting of the neck, with a headache.
At the lumbar level, it manifests itself with lumbar pain and stiffness, especially in the morning, pain in the buttock and thigh, pain in the extension of the spine, and its rotation and lateral inclination. Often the patient assumes a forced position to the right or to the left and has difficulty standing or sitting for a prolonged period. The pain improves with bed rest and bending forward. In the case of facet hypertrophy, compression on the nerve can also occur with the appearance of radicular pain.
Facet Joint Arthropathy Diagnosis
The radiograph of the spine in 3 projections (anteroposterior, lateral, and oblique) is often able to provide information on the conformation of the articular facets.
The CT scan also provides additional information on adjacent structures.
NMR is useful for excluding other pathologies such as disc herniation and disc alterations in general.
The definitive diagnosis, however, is obtained by injecting a mixture of anesthetic and anti-inflammatory into the affected joint facet, under control in scopy: if the pain immediately disappears, the diagnosis is confirmed.
Conservative therapy is based on the administration of anti-inflammatory drugs, pain relievers, and muscle relaxants.
Physiotherapy is very useful for improving the flexibility of the spine and restoring correct posture.
In case of failure to respond to conservative and physiotherapeutic therapies, it is possible to inject steroids directly into the facet joint under control in scope. This procedure can lead to pain relief even for long periods.
In case of failure of this therapy as well, it is possible to intervene with radiofrequency denervation of the facet joint nerve. With this method, painful stimuli coming from the joint facet are blocked, leaving its anatomy and functionality preserved. The procedure is performed under local anesthesia under radiological guidance percutaneously without the need for incisions.
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