The spinal column is composed of a number of structures. The most delicate is the collection of nerves that operates our muscles and allows us to move. Those nerves are called the spinal cord, which is protected by a combination of bones, disks and ligaments called the spinal column. The bones have a number of joints called the facet joints that give the spinal column its flexibility and allow it to bend and twist. We have facet joints at every level of the spine, including the neck, mid and low back. Gradual deterioration of these joints develops as we grow older. By 50 years of age, 100 percent of people X-rayed will have arthritis in the facet joints. Fortunately, most people are not symptomatic. However, a significant number of people develop pain due to arthritis in these joints.
Patients with cervical facet arthritis will complain of pain in the neck that can also be felt in the back of the head, shoulder or arm. The pain is usually worse with neck movement. In the lumbar spine, facet arthritis causes low back, hip and thigh pain. The pain is usually aggravated by extension or bending backwards. When the doctor examines the patient, he or she will find tender muscles overlying the lumbar or cervical facets. The diagnosis can be confirmed with plain X-rays and CT scan studies.
In the event of a sudden flare up, bed rest, ice over the painful area and anti- inflammatory agents such as aspirin or Motrin will usually bring relief. Sometimes a sudden flare-up can also cause muscle spasms. In this case, the doctor can prescribe muscle relaxants in addition to the anti-inflammatory agents. Once the situation is stabilized, a cautious increase in activity can begin. Over a period of a few weeks, most flare-ups will resolve without invasive treatment. If a significant amount of pain remains, the patient can be treated with physical therapy using ultrasound, back exercises, traction and soft tissue mobilization or massage. If physical therapy does not completely resolve the discomfort, the patient can be referred to a specialist for local injections into the inflamed joints. Under X-ray, these joints can be injected with a powerful anti-inflammatory drug, usually bringing relief within 48 hours. The X-ray procedures are customarily performed under light intravenous sedation with drugs like Valium so that the patient is comfortable during the procedure.
Preventing flare-ups is essential.
- The most critical factor in cervical facet arthritis is sleep position. It is best to use a firm non-feather pillow that keeps the neck in good alignment with the rest of the spine while sleeping. If you routinely sleep on your back, use a fairly narrow pillow that does not bring your head too far forward, but once again, keeps it in good alignment.
- In preventing back injuries, be careful bending, lifting and twisting. Ideally, patients with low back problems should attend “back school” offered by a physical therapy department in order to learn how to take proper care of the back.
- Proper strength training.
- Proper flexibility training.