Multilevel degenerative disc disease and facet arthrosis

Neck and spine Overview Treatment

The facet joints are joints in the spine located in the back (posterior) aspect of the spine. There are facet joints at each vertebral level, one on each side of the spine. These joints provide flexibility (allow the spine to turn or bend with movement) and stability (prevent excessive motion). Facet arthritis happens when the cartilage that covers the ends of the joints wears out and becomes thin. This can contribute to the growth of osteophytes (bone spurs) and hypertrophy (enlargement) of the joints.

Facet arthritis can be associated with pain and stiffness. The pain from an arthritic facet joint is often felt in the spine near the joint, but it can also refer to other locations. For example, pain from cervical (neck) facet arthritis may radiate toward the back of the head, ear, or shoulder. Pain from lumbar (low back) facet arthritis may radiate toward the buttock, hip, or thigh. The pain is often worse with certain movements or after a period of inactivity or sleep.

Risk factors for facet arthritis include age, history of trauma, degenerative disc disease, poor posture, and family history of degenerative arthritis.  

A careful history and physical examination is often enough to diagnose facet arthritis as a potential cause of pain. Imaging of the spine (X-ray, CT scan, MRI) can also show changes consistent with facet arthritis. If it is not clear that the facet joint is causing the pain, a diagnostic (anesthetic) injection of the facet joint can provide valuable diagnostic information.  

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Degenerative disc disease refers to the changes that occur to the spinal discs as part of the body's natural aging process. Spinal discs separate the vertebrae, the interconnected bones of which the spine is composed. While degenerative disc disease can occur anywhere within the spine, it most commonly affects the neck (cervical) and the lower back (lumbar) areas.

In addition to age, degenerative disc disease can occur as a result of small tears in a disc. These small tears lead to the release of nucleus, a jelly-like material found in the disc, which can cause the disc to bulge or rupture. Degenerative disc disease can also stem from a herniated disc. As with many conditions, those who smoke or are obese are at a higher risk of developing degenerative disc disease.

The symptoms of degenerative disc disease vary. Depending on the location of the degenerating disc, individuals may experience pain in the neck, back, arm, leg, or buttocks. In some cases, no pain is experienced, causing the condition to remain unnoticed. It is important to see a doctor if you experience persistent pain in any of the aforementioned areas.

To diagnose degenerative disc disease, your doctor will perform a physical evaluation and review your medical history. The physical examination typically entails inspecting the affected area for tenderness, changes in range of motion, as well as other potential conditions, such as infection or fractures. In some cases, x-rays may also be used to obtain a better view of the discs.

Degenerative disc disease can often be managed with over-the-counter pain medications, such as acetaminophen or ibuprofen, and applying ice or heat to the affected area. More aggressive treatments may not be necessary unless additional conditions, such as osteoarthritis, have developed as a result of the degenerating disc. Such cases may require physical therapy or surgery to remove the degenerated disc. Your doctor will develop a customized treatment plan for your individual condition.

The doctors in the Stanford Medicine Spine Center are leaders in the diagnosis and treatment of facet arthropathy (pronounced “fuh-SET ar-THROP-uh-thee”), a form of arthritis affecting joints in the spine.

We personalize a treatment plan to help relieve your symptoms, which most commonly include pain in the lower back. Our team also can guide you to the best diet and exercise for your condition. We can even help you and your family members take action to reduce the risk of developing facet arthropathy or lessen its impact.

In addition, Stanford Medicine Spine Center patients with facet arthropathy may have opportunities to participate in research studies of new treatment approaches not yet available anywhere else.

• Center of Excellence for advanced care of all spine-related conditions.
• Nationally recognized expertise in treating all types of facet arthropathy cases, no matter how complex.
• Precise diagnosis options including the latest imaging technology.
• Team-based treatment planning that brings together orthopaedic surgeons, neurologists and neurosurgeons, pain management specialists, rheumatologists, physiatrists, and others to tailor care to your needs.

• Advanced treatment options emphasizing noninvasive approaches whenever possible, including exercises, physical therapy, and medication therapy, and, when needed, spine surgery.
• Comprehensive support services including care coordination from diagnosis to treatment to follow-up.
• Active research program to develop new diagnostic and treatment advances.

The team members of the Stanford Medicine Spine Center use the most advanced techniques to effectively treat facet arthropathy, a form of arthritis affecting joints in the spine. We have experience with all treatment approaches and use minimally invasive techniques whenever possible.

Our team includes doctors from orthopaedics, rheumatology, physiatry, neurology, and other specialties, working together to help ensure you receive an accurate diagnosis and the most effective treatment possible.

Our treatments focus on:

• Reducing pain, stiffness, and inflammation
• Keeping your condition from getting worse
• Helping you continue or resume doing your daily activities

Treatment options include:

Our specialists focus on treating your symptoms and keeping your condition from getting worse.

• Physical therapy
• Anti-inflammatory medications
• Improved control of motions that cause pain (for example, lifting, twisting, and stretching)

• Surgery, such as removing the bone spurs that are the result of facet arthropathy, to relieve nerve root compression. This may also be paired with a spinal fusion, if indicated.
  
• Facet joint ablation (also known as facet radiofrequency ablation): use of electric shocks to prevent nerves of facet joints in the spine from sending pain signals to the brain

The spine continues to wear down as we age. However, treatment can help relieve pain and other symptoms, and help you get back to activities you love.

Prevention

It may not be possible to prevent facet arthropathy, but there are steps you can take to reduce your risk of developing it. For example:

• Keep a healthy body weight.
• Exercise regularly—ideally, low-impact activities such as walking and swimming.
• Eat a balanced diet.
• Avoid injuries. Use proper lifting techniques. Don’t lift objects that are too heavy. Wear protective equipment when playing sports.

• Keep a good posture. Sit, stand, and walk as straight as possible.
• Talk with your doctor about vitamin supplements. You may benefit from calcium, vitamin D, or another supplement. But always talk with your doctor before starting any new prescription or over-the-counter medications or supplements.
• If you smoke, quit. If you don’t smoke, don’t start. It’s bad for your bones (and other parts of your body too).

Clinical trials are research studies that evaluate a new medical approach, device, drug, or other treatment. As a Stanford Health Care patient, you may have access to the latest clinical trials.

Open trials refer to studies that are currently recruiting participants or that may recruit participants in the near future.

Closed trials are not currently enrolling, but may open in the future.

Facet arthropathy is a form of arthritis affecting joints in the spine.

Facet joints are located on the back of your spine. They help provide a counterbalance to the discs inside your spine’s vertebrae (the small bones that form your backbone). Facet joints help control the motion of your spine so that the vertebrae stay in a healthy position.

As we age, our facet joints wear down. When arthritis occurs in these joints, we call it facet arthropathy.  

The Stanford Medicine Spine Center delivers precise diagnosis and advanced management of facet arthropathy, a form of arthritis affecting joints in the spine.

Our specialists provide the full range of treatments to relieve pain, stiffness, and other symptoms of facet arthropathy.

For each patient, our goal is to deliver personalized care and the most effective, least invasive treatment possible.

Our Clinics

The Stanford Medicine Spine Center is staffed by world-class spine specialists from neurosurgery and orthopaedics, who work together to offer you the world’s most advanced and effective treatment options—including those that don’t involve surgery. Our goal is to safely get you back to your normal lifestyle as soon as possible, and maintain long-term spinal health.

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