What is facet hypertrophy ?
Facet hypertrophy definition
Facet Hypertrophy is an enlargement of the facet joint. It may increase to the point where the nerves in the vertebrae are under pressure and may lead to the lateral recession with subsequent radiculopathy. The hypertrophic degenerative joint is also a source of pain on its own.
The inferior articular process of a vertebra with the superior spinal processes of the adjacent lower vertebra forms a facet joint, also known as the zygapophysial joint.
The facet joint is a synovial joint, as opposed to cartilaginous or fibrous joint. This means that the joint is surrounded by a capsule, which is filled with lubricating fluid.
The facet joint guides the flexion, extension and the rotation of the spine, while limiting motion in all directions to the appropriate degree.
Most Often Treated
A facet joint hypertrophy most often occurs in people above the age of thirty.
Facet hypertrophy causes
Osteoarthritis and overloading of the joint are the most common causes of facet hypertrophy.
The most common cause of overloading is degenerative disc disease, which causes the disc height to shrink and consequently the bony components of the facet joint to place increasing pressure on each other.
This type of pressure is also thought to increase the growth of osteophytes in the facet joint.
People with condition often adapt their posture to avoid pain, so they may walk hunch over, depending of the location in the spine of the condition. They often complain of stiffness and back pain.
Diagnosis of a hypertrophic facet disease is made by imaging.
Confirmation of this pain generator can be made by injection of a local anesthetic into the joint.
If the patient experiences a corresponding relief of pain, this is confirmation of painful Facet Hypertrophy.
Correlation between symptoms and imaging findings can lead to nerve compression by Facet Hypertrophy.
Facet hypertrophy treatment
Conservative treatment is usually considered a temporary solution. The underlying condition is usually degenerative and will usually worsen in time. This is particularly true in the facet joint is overloaded due to disc height loss from degenerative disc disease.
- Analgesic injections
- Steroid Injections
- Anti inflammatories
If pain is severe and continuous, or if there are neurological deficits, surgery may be recommended.
Surgical options include:
- Facet Joint Replacement
- Facet Arthroplasty
- Percutaneous denervation (to quell nerve transmission of pain – no significant disc height loss)
- Artificial Disc Replacement
- Dynamic Spine Stabilization (DSS) to unload and realign the facets
- Interspinous Process Decompression
All surgery carries risks from anesthesia, blood clots and infections. If complications from these risks arise, they most often can be successfully treated. The physical condition of the patient (such as obesity and diabetes) can also add risk to surgery.
Surgery Long Term Outlook
The appropriate surgical procedure properly executed will provide long term relief for the degenerated disc(s) treated.
However, if the condition was allowed to continue too long and the nerves have become damaged, there may be some remaining pain or numbness or no improvement.
Also, any degenerative process will likely continue, therefore problems in other areas of the spine may appear at a later time.