The human spine is like a ladder made up of 24 steps, called vertebrae, stacked on top of one another to create the spinal column. This ladder gives the body its form, our main upright support.

In the middle of each rung of the ladder lies a hook, the spinous process, that hangs downwards. These are the bony points you press when you run your fingers down someones mid-back.

Now imagine this “ladder” with ropes and rubber tied around its connections. These are the ligaments, tendons that aid movement and the nerves that carry electrical signals to and fro. The friable joint capsules and the tough muscles and fascia act like clothing and leather that isolate and protect all these structures.

Now for the wonder of this structure: this ladder can bend forward, backwards, and rotate on its own base….and is expected to do so thousands of times daily for over a hundred years!!

“Oh dear!” my patient said. “No wonder things go wrong with our backs.”

One of the many things that can cause back pain are the facet joints.

These lie at the ends of each step of the imaginary ladder, in the area where you would hold as you climb up with both hands.

The facet joints of the lower back allow you to bend forward and back. Their surfaces are covered by articular cartilage, a smooth, rubbery material that covers the ends of most joints.

Causes of Facet Arthritis

As a vertebral disc thins with aging and from daily wear and tear, the space between two spinal vertebrae shrinks. This causes the facet joints to press together. Facet joints can also become arthritic due to a back injury earlier in life. Fractures, torn ligaments, and disc problems can all cause abnormal movement and alignment, putting extra stress on the surfaces of the facet joints.

Symptoms develop slowly when degeneration is causing the problems. However, rapid movements, heavy twisting, or backward motions in the low back can injure a facet joint, leading to immediate symptoms.

Pain from facet joint arthritis is usually worse after resting or sleeping. Also, bending the trunk sideways or backward usually produces pain on the same side as the arthritic facet joint. hyperextend the spine.

Pain may be felt in the center of the low back and can spread into one or both buttocks. Sometimes the pain spreads into the thighs, but it rarely goes below the knee. Numbness and tingling, the symptoms of nerve compression, usually occur when bone spurs and disk issues are encroaching the holes (neural foramen) through which the nerves pass.

Diagnosis

The diagnosis of facet arthritis start to form from listening to the details of your complaints. Physical examination confirms or excludes other possibilities. An Xray, CT or MRI scan may show definitive evidence, however a negative radiology doesn’t rule out facet arthritis.

A test injection into the suspected joint may also confirm the diagnosis if the pain is relieved.

Treatment

Facet joints are the primary cause of chronic low back pain 15 percent of the time. Generally conservative treatment suffices. Mild to moderate strength pain medicines, anti-inflammatories, muscle relaxants and other supportive drugs are usually enough. Bed rest and physiotherapy may be necessary before and after injections of the specific facet joints.

The joints are injected with local anaesthetic and steroid mixtures under Xray guidance. This may give relief lasting weeks to months, and is often repeated.

If these injections work well, the nerves that carry pain signals from the facet joints can be destroyed by heat, a process called radio frequency ablation.

This treatment can give relief for a year or more, until the nerves rejoin again, and can be repeated. Radiofrequency ablation has been shown scientifically to be very effective. It is available in Nigeria.

Surgery, though rare, will involve either a facet rhizotomy or posterior fusion. Rehabilitation may take many months and the risk of a new pain condition is very high.