Cervical Facet Joint Arthropathy

Arthritis in the facet joints of the neck is the most common cause of chronic neck pain - pain lasting more than three months. A proper diagnosis is needed so that the right treatment program can be developed and followed between the doctor and patient with cervical facet joint arthropathy.

Editorial note: Not mentioned in this video is the use of chiropractic manipulations, which can be useful as part of a comprehensive treatment plan for cervical facet joint arthropathy.

Video presented by Grant Cooper, MD

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Video Transcript

Cervical Facet Joint Arthropathy is basically irritation of the facet joints in the neck. The facet joints in the neck are hinge joints in the neck that resist extension, they resist lateral rotation of the neck. The facet joints are basically synovial joints, so they are like your knees, your shoulders, your hips, your fingers - they have all the same basic parts as these mobile joints. Just like a knee, a shoulder, a hip, you can tear the capsule, they can become arthritic, they can cause pain. When cervical facet joints cause pain - and they are the most common cause of chronic neck pain, chronic being anything that lasts longer than three months - they tend to cause pain that is dull, achy, it tends to refer into the trapezius, sometimes around the shoulder blade. Sometimes, depending on the facet joint that's involved, it will refer pain up into the base of the skull and sometimes it will radiate up into the head.

How is Cervical Facet Joint Arthropathy Diagnosed?

Diagnosis of cervical facet joint pain certainly begins with a history, physical examination. The history and physical is always the most important thing whenever trying to establish any kind of diagnosis and, at the same time, it may lead one toward that diagnosis, but it will never exactly be able to definitively state that diagnosis. Our imaging studies like MRIs, CAT scans, x-rays, those too don't really definitively diagnostic facet joint pain. Sometimes on an MRI you will see synovitis or inflammation in the facet joint, but typically what you'll see is some arthritis in the facet joints in older people and sometimes they'll just look normal. The gold-standard diagnosis of facet joint arthropathy or pain coming from the facet joint rests on putting a needle under an x-ray next to the facet joint, putting a little bit of anesthetics - lidocaine, novacaine - and taking the pain away and when you're able to take the pain away by putting a little bit of lidocaine next to it, that's when you can be confident that the pain is actually coming from the facet joints.

How is Cervical Facet Joint Arthropathy Treated?

There are three basic ways of going about treating cervical facet joint arthropathy or pain coming from the cervical facet joints. The first is biomechanical - physical therapy, stretching, strengthening, it's postural exercise. It's basically getting the muscles to support the spine so that the spine has a chance to heal and take care of itself, in a sense. Often that goes a long way to taking the pressure off the joints and helping people to essentially allow the joints to heal themselves. Sometimes when that's not working or if the pain is interfering with the person's ability to participate in physical therapy, then what one can do is put a needle, under an x-ray, into the cervical facet joint and do an injection of steroid to take away the inflammation from within the joint. Now, doing an injection into any joint is not going to change the arthritis, is not going to change a tear in the capsule. It's not going to mask anything either. What you're going to do is you're going to reduce the inflammation and dial the inflammation back down to zero, ideally. What this does is: 1) it allows people to, perhaps, do more with the physical therapy, do more of the exercises and 2) it offers this window of opportunity during which, if you can take advantage of the time when the pain is not there and when the inflammation is not there and tweak the biomechanics, then, ideally, the pain is not going to come back, the inflammation is not going to come back and then you won't be sitting there in three, six, eight months having to do things again.

Now, the more definitive treatment of cervical facet joint arthropathy and cervical facet joint pain is something called radiofrequency rhizotomy, which is basically putting a needle, under an x-ray, next to the medial branch of the dorsal ramus - another way of saying the little sensory nerve that innervates the joint - and by using radiofrequency energy, you can actually deinnervate the joint. So, it's like the phone is still ringing, but you cut the cord so you don't hear it. The facet joint may still be arthritic It may still have a tear in the capsule. It may still be causing pain were there a sensory nerve, but since there is no sensory nerve, you don't feel that pain. That nerve tends to regenerate and over a period of six to eighteen months - typically around a year - the nerve will tend to grow back and the pain will tend to return and then you have to do it again. So, ideally, even when you do a cervical facet joint rhizotomy, you still think of that more as a window of opportunity during which you should still really be focused on posture and exercises to help unload so that, hopefully, as that nerve regenerates (should it regenerate), the biomechanics have shifted enough so that the pain doesn't return and the procedure doesn't have to be repeated.