Spinal Arthritis (Facet Arthropathy): Treatment Options

Spinal Arthritis (Facet Arthropathy): Treatment Options

This video will review the treatment options for spinal arthritis, also known as facet arthropathy. After a patient has been diagnosed with facet arthropathy and other spinal conditions have been ruled out, discussions with a health care professional will identify the patient's lifestyle, symptoms and treatment goals. Ultimately, treatment for facet arthropathy aims to reduce pain, improve spinal movement, and support daily activities. Treatment is often approached in a stepwise manner, starting simple and progressing as needed. Most patients successfully reduce symptoms without surgery.

The first step of nonsurgical treatment includes conservative options such as oral medications like ibuprofen or acetaminophen, which may help reduce inflammation and pain associated with arthritis. Activity modification to reduce impact and stress on the facet joints, especially if the patient's intervertebral discs have decreased shock absorption. And physical therapy, which aims to strengthen surrounding muscles, reduce tension, and support smooth movement.

If pain continues, the next step is to trial pain management, which may prescribe stronger oral medications or begin other treatments, such as: numbing or steroid injections at the site of arthritis, or radiofrequency ablation, in which a physician uses x-ray guidance to place a needle near the facet joint. The end of the needle gently heats the medial branch nerve, reducing the pain signals it sends to the brain. If pain management treatments provide temporary relief but symptoms continue to return, surgery may be considered as a longer term treatment option.

It is important to note that the small facet joints in the spine cannot be replaced with metal and plastic implants, the same way that larger joints, such as the knee or hip, can. For patients whose symptoms are caused primarily by facet arthropathy, one surgical option is medial branch nerve transection. During this procedure, the surgeon directly visualizes the medial branch nerve, often using an endoscope, which is a small camera with a channel for tools to pass through. The surgeon carefully transects, or cuts, the nerve. Because the medial branch nerves are sensory nerves, interrupting them prevents pain signals from reaching the brain. These nerves do not control muscles, so cutting them does not affect spinal movement or function. After the surgery, activity is briefly limited and increased gradually as the patient allows.

If a patient has other spinal conditions, such as severe disc degeneration or other complex spinal disorders, other surgical treatments may be considered. These procedures have different recovery protocols and timelines for returning to activity.

To summarize, most patients with facet arthropathy have successful symptom reduction with nonsurgical treatment. The treatment plan progresses stepwise, starting with nonsurgical treatment options. Surgery is generally considered when nonsurgical treatments fail to provide lasting relief. Medial branch nerve transection is a minimally invasive surgical option when treating pain caused by facet arthropathy.