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Facet joint hypertrophy

Facet joint hypertrophy is an enlargement of the facet joints between vertebrae caused by degeneration or inflammation in the spine. The facet joints are cartilage-encased hinges that hold the bones of the spine together. If they degenerate or become inflamed, pain results.

Degeneration may be caused by osteoarthritis of the spine, which results in a gradual wearing away of the cartilage and the growth of extra bone to compensate, called bone spurs. Rheumatoid arthritis, which can cause swelling of the synovial lining of the facet joints, is the most common cause of inflammation.

Hypertrophy of the facet joints can cause spinal stenosis. The condition usually worsens over time.

Symptoms

The pain associated with facet joint hypertrophy arises from the effect of joint enlargement on the spinal nerves.

  • Localized back pain
  • Localized neck pain
  • Pain that radiates to other parts of the body
  • Stiffness
  • Numbness in the buttocks and legs
  • Reduced mobility
  • Spinal deformities
  • Height loss
  • Inability to arch the spine backwards


Diagnosis

  • CT of the spine to determine the extent of damage
  • Facet joint nerve blocks to detect nerve root entrapment


Treatment

Your doctor may recommend injections of corticosteroids and anesthetics, such as lidocaine and bupivacaine, into the joint to provide relief from pain. The use of fluoroscopic radiography ensures that the injection is made into the inflamed joint.

Physical therapy may be prescribed, with treatment that includes heat, ice, electrical stimulation and ultrasound to help relieve pain. Specific exercises may help you regain flexibility and strengthen core muscles that control the movement of the vertebrae and ensure proper alignment of the facet joints.

Your doctor may recommend surgery if your pain is severe. The goals of surgery are relief of nerve compression and joint pain and restoration of normal function. Surgical options include:

  • Spinal fusion using bone grafts or hardware to fuse two vertebrae together
  • Decompressive laminectomy to remove the lamina, part of the bone that makes up a vertebra, or bone spurs in your back
  • A combination of the two procedures

 

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