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Thursday, November 14, 2013

Patient Information: Lumbar (low back) Facet Joint Degeneration, History - Part I

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                What are Lumbar (low back) Facet Joints?

Our Facet Joints are the joints located on the back of our spine opposite the disc, which is located in the front of the spine between the bodies of the vertebrae. The facet joints are made up by bone pieces (articular processes) from the vertebrae next to each other. Each vertebra contributes one articular process to the joint.
The facet joint itself has cartilage like many other joints in the body. Each joint is surrounded by a tough capsule which strengthens the joint.


This illustration of the low-back (lumbar spine) shows the spine from the side. The spinal discs (blue) are located between the vertebrae in the front of the spine, whereas the facet joints (green) are located on the back of the spine.

                    What is the Facet Joint's Function?

The facet joints move like windshield wipers when looking at them from the side. Flexion (forward motion) and extension (backward motion) are the primary motion of the facet joints. They also prevent the spine from slipping sideways in the horizontal plane (shearing).


This illustration shows the Facet Joints of the low-back (lumbar spine) from the side. The front of the spine is to the left. The discs are shown in red. The spinal nerves can be seen traveling from the inside of the spine outward through the nerve channels. The two lowest Facet Joints of the low-back are outlined by the circles.
What causes Degeneration of the Lumbar (low back) Facet Joints?

Facet joint degeneration is a common problem and is expected to some degree as our spine ages. A contributing factor to this is the thinning of the disc as we age. The loss of the height of the disc will place more weight onto the facet joints, which begin to show signs of stress. Ordinarily, the facet joints carry 20% of the body’s weight. However with loss if the disc’s height and function, up to 50% of the body’s weight may have to be carried by these joints. Over time, these joints will lose their cartilage and the joint space narrows. Eventually, the joins enlarge as the two bones which make up the joint (articular processes) begin to make contact. As these articular processes rub against each other, they form new bone, resulting in spurring and enlargement of the joint. In addition, facet joint cysts can form.

Which Facet Joints are most commonly affected by Degeneration?
Facet joint degeneration is most commonly present in the same spinal segments most affected by degenerative disc disease, namely the L4/5 and L5/S1 levels in the low-back.
This illustration shows the low-back (lumbar spine) from the side. The front of the spine is to the right, the back to the left. The discs are shown in red, located at the front of the spine. Two facet joints at the bottom of the spine are circled.
What are the Common Symptoms of Lumbar (low-back) Facet Joint Degeneration?
Patients with facet pain will often suffer from pain next to the middle of the spine (paraspinal).
Facet related spine pain is often worse when the spine is bent backwards. This is called “facet loading” as more weight is distributed to the facet joint and away from the disc. Contrary to that, patients with disc related pain typically feel worse when bending forward. Facet pain is also often located in a smaller more defined area, whereas disc related pain can spread more. Here are some of the symptoms:
1.     Low-back pain
2.     Low-back stiffness
3.     Low-back muscle spasms
4.     Pain radiating to the hips and buttocks
5.     Worsening pain when looking up
In our Next Blog we will discuss the Diagnosis and Treatment of Lumbar (low back) Facet Joint Degeneration!

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