Facet Hypertrophy Treatment, Symptoms & Actual Cause
Facet pain, facet arthritis, and facet hypertrophy treatment by our non-surgical experts and breakthrough technology improve you faster. Get the best facet hypertrophy treatment for the neck and back without injections, RFA (radiofrequency ablation), or other surgery forms; call us now!
Let’s look at what a facet is before getting into the details of facet hypertrophy. Facet Hypertrophy refers to degenerative and arthritic changes (osteoarthritis and osteophytosis or bone spur) impacting the facet joints of the cervical, thoracic, or lumbar spine. The spinal facet (spinal joint), by definition, is a pair of structural surfaces, faces, or angles that are slanted.
Facets are boney projections that connect spinal bones to form spinal joints in all spine segments except at the C1-C2 (atlantoaxial joint). The union of two or more spinal segments is through four facets:
- Two superior facets
- Two inferior facets
The spinal motion segment is two or more vertebrae (spinal bones) that cornet via facets or spinal joints. Spinal joint forms when the superior facets of the vertebrae below connect to the inferior facets of the vertebrae above. The atlantoaxial joints of the 1st and 2nd neck bones are through the articular condyles.
Spinal Motion Segments & Facets
Here are some basic facts on facets & spinal motion segments:
- The first spinal joint formed by the union of facets is the C2-C3 motion segments.
- The most mobile spinal motion segment in the neck is the C5-C6
- The L4-L5 is the most mobile motion segment of the lower back.
- Facet joints or spinal joints, also known as zygapophyseal joints or zygapophyseal joints, are synovial joints.
- Zygapophyeal joints or facet joints are covered with fibrocartilage or hyaline cartilage and lined with a synovial membrane.
There are two facet joints in one motion segment. A motion segment is where two contiguous (adjacent or touching) spinal bones are connected by facets that allow motion, mobility, and weight-bearing. The neck and lower back facets are the common areas diagnosed with facet hypertrophy. We have listed the six most common sites for facet hypertrophy blow:
- Cervical Facet Hypertrophy: Cervical facet hypertrophy results from premature wear and tears of neck joints caused by injuries, prolonged computer use, or tech, often diagnosed at C4-C5, C5-C6, or C6-C7 motion segments
- Lumbar Facet Hypertrophy: Facet hypertrophy of the lumbar spine is often the result of injuries or prolonged sitting. Lumbar facet hypertrophy can be seen in any five lumbar segments but is more common in L3-L4, L4-L5, and L5-S1.
Hypertrophy Facet Joints, Facet Arthritis, Osteophytosis Or Spinal Bone Spur
The human spine consists of twenty-five moveable bones known as a vertebra or spinal bones. These vertebrae stack on top of one another to create the spinal column. The spinal column gives the body support, allows movements, and protects the spinal cord and spinal nerves.
As mentioned, the coming together of facets connects or joins vertebrae to establish spinal motion segments for mobility. The coming together of a facet from the vertebra above and connecting to the vertebra’s facet below forms the facet joint. Facet joints are the smallest in the neck and most abundant in the lower back.
A properly aligned spinal joint allows for effortless motion in the neck, upper back, mid-back and lower back. Movement and mobility afforded to a facet joint are due to the articular cartilage and synovial membrane lining.
Daily stresses, traumatic events, prolonged sitting, and poor postures can result in wear and tear of these joints and their associated structures, including the facet joint’s soft tissues. The wearing out or degenerative changes of a facet joint are referred to as facet hypertrophy. In facet hypertrophy, the facets expand with arthritic bones or spurs to counter the wear and tear resulting from the degenerative changes.
What Are The Common Symptoms Of A Spinal Joint Degeneration?
Symptoms of a hypertrophied facet joint (spinal joint degenerations) are depended on the site of involvement. If facet hypertrophy is in the neck, you could feel neck stiffness, neck pain, loss, decreased range of motion in the neck. Similarly, if the hypertrophy is in the lower back, back pain, pain in buttocks, or difficulty standing following a period of sitting could result. The vast majority of facet patients will complain of increased stiffness, discomfort, or pain after sleep. To help you understand facet degeneration, facet arthritis, or osteophytosis (hypertrophied facets, we have listed the most common symptoms below:
- Stiffness, discomfort, or pain in the affected joint or region of the spine
- Loss of mobility or restricted motion to one or both sides
- Pain upon bending forward or extension
- Discomfort or pain with side bending or the spine to one or both sides
- Pain that worsens with a change of position
Facet hypertrophy is a condition that results after generative changes in the spinal disc. Often, a patient with facet hypertrophy also presents with a slipped disc or slip disc. Another common condition that co-occurs with a hypertrophied facet is ligamentum flavum hypertrophy, spinal canal stenosis, cervical spondylosis, and sciatica (leg pain and sciatica). We highly encourage you to read about these conditions when you have finished reading this article. Hypertrophy of facets is bone spurs and arthritic formation. With bigger spurs, your risks of nerve compression increase significantly.
Symptoms Of Cervical Spondylosis
Symptoms of nerve compression occur in moderate or severely hypertrophied facets or spurs. A bone spur that approximates spinal nerves or the spinal cord can compress and irritate the delicate nerve fibers. Symptoms of a compressed nerve root or spinal cord resulting from a bone can include:
- Pain in arms or leg pain
- Pins and needles in the arms or the legs
- Weakness in shoulders, arms wrists
- Weakness in hips, legs, knees, and ankles
In chronically hypertrophied conditions, it may even lead to paralysis of arms or legs. In short, facet hypertrophy can become a nightmare scenario that impacts the quality and the quantity of life.
What Causes Hypertrophy (Arthritis & Degeneration) Of A Facet Joint?
The spine is a critical pillar the body needs for function and mobility. Like a pillar, the spine holds the body in an upright position. The vertebral discs and the vertebral body mainly carry out the weight-bearing function of the spine. Vertebral discs or spinal discs are tough, sturdy pads made of cartilage. The vertebral body is the large bony structure that the spinal discs connect to via the vertebral endplate. You may learn more about the vertebral discs by visiting the spinal disc page. The weight-bearing structures of the spine are the spinal disc and facets (spinal joints).
Spinal joints or facet joints have minimal weight-bearing functions in the upright position. When the spine is in the flexed position, there is no weight transmitted onto the facets. However, with extension, some weight is transferred onto the facets. So, the primary function of a facet joint is to allow mobility. Weight-bearing is a distant second. But, when the spinal discs degenerate significantly, the facets are put under increased stress. With severely degenerated spinal discs, the facets or spinal joints become the main weight-bearing structure in the spine.
Axial Loading Cause Degenerative Changes in Spine & Facet Hypertrophy
The spinal bones and spinal discs provide the needed weight-bearing activity or function. Under normal situations, the spinal joints on both sides of the spine fit snugly without stress.
However, modern lifestyles and load-bearing activities that cause the spinal discs to degenerate can stress the facet joints. As the stress accumulates, the cartilage covering these joints and the synovial membrane react with inflammatory processes. In other words, when facet joints are stressed, it swells up. An unabated inflammatory process within a facet joint is the primary factor in facet hypertrophy. But, for a facet joint to undergo this inflammatory process, there has to be some spinal disc damage.
The human body reacts to the excess pressure by creating bone spurs. Since they form around the edges of the joints, the joints become enlarged. At some point, the surfaces become arthritic. When the articular cartilage wears off or degenerates, the bone underneath is uncovered and rubs against the bone. The joint becomes painful, swollen, and inflamed.
What Causes The Osteoarthritic Changes Or Osteophytosis In Joints Of The Spine?
Before answering this question, it will be better to differentiate osteoarthritis from Osteophytosis. Osteoarthritis is the most common form of arthritis. In osteoarthritis, the protective cartilaginous covering of a joint is damaged or worn out. Osteophytosis or osteophytes are the spurs that form after the onset of osteoarthritis. However, in some cases, it can coincide. A loss in spine range of motion, stiffness, discomfort, and pain may arise when osteoarthritis and osteophytosis (bone spurs) impacts spinal joints.
According to published medical research, the spinal facet joint is at higher risk of developing osteoarthritic changes and osteophytic changes (facet hypertrophy or spurs) than any other Joint. As mentioned, disc degeneration always precedes any facet hypertrophy or arthritic changes. Although the most common symptom is stiffness, discomfort, pain, or lack of mobility, facet hypertrophy (arthritis or spur) can remain asymptomatic. Pain or symptoms associated with facet hypertrophy are often the results of increased physical activity with an existing spine condition such as degenerative disc disease, disc bulge, or disc herniation. A thorough assessment and diagnostic imaging are needed to examine the extent of damage and actual cause compressively.
How Is A Hypertrophied Spinal Joint (Arthritic Joint) Diagnosed?
Diagnosing facet hypertrophy starts with getting your medical history, followed by a thorough physical assessment. A CSC chiropractor will perform a series of orthopedic and neurological tests. If the physical tests performed indicate facet arthritis (facet hypertrophy), diagnostic imaging would be needed. The best diagnostic image is the MRI.
Facet hypertrophy will always have some degree of damage to the soft tissues. The soft tissues of a facet joint or spinal joint are the encapsulating ligaments and ligamentum flavum. Stresses that deteriorate a spinal joint also degenerate and damage the joint’s ligaments (soft tissues). An MRI assessment or exam offers an in-depth look at the joint surface and its associated soft tissues, including ligamentum flavum. Hypertrophy of ligamentum flavum is the inflammation, scarring, and eventual thickening of the ligamentum flavum.
Another crucial diagnostic imaging tool is the Computed Tomography or CT Scan. A CT Scan is the best means of assessing arthritic bone formation. It is superior to the MRI but cannot provide information on damage caused to the soft tissues and the MRI dose.
Spine x-rays can also be used. X-rays are somewhat outdated as a means of diagnosing the spine. Furthermore, X-ray exams and CT Scans are limited but helpful. MRI, in our opinion, is superior to X-rays, and CT scans expose patients to radiation.
RFA or Radiofrequency Ablation: A Minimally Invasive Surgery For Facet Mediated Pain
A facet mediated pain is a condition in which your spinal joints are the leading cause of your neck or back pain. Surgeons tweaked facet mediated pain off neck and back two steroid injections or radiofrequency ablation surgery. Radiofrequency ablation is a minimally invasive spine surgical procedure designed to kill the pain-sensing nerve known as the medial branch nerve.
In the Radiofrequency ablation (RFA or RF ablation) procedure, the surgeon inserts three specialized needles connected to the radiofrequency ablation machine to send strong radio waves that heat the tip of these needles. Heating the tip of the needles is the aim or goal that destroys and kills the medial branch nerve. This procedure is fast becoming popular as it can be done to local anesthetic, taking one to two hours to perform. However, the long-term consequence of such a procedure is still not well understood.
Consequences Of Radiofrequency Ablation Facet Mediated Pain Resulting From Facet Hypertrophy
The medial branch of the spinal nerve senses pain that originates from the spinal joint (facet mediated pain). Moreover, this nerve provides essential controlling mechanisms on the spinal joint ligaments and spinal muscles. For example, the multifidus muscles, a small group of muscles alongside the spine, are controlled and innervated by the medial branch nerve.
Radiofrequency ablation therapy that destroys the medial branch nerve will have negative consequences for the multifidus muscles. What makes the multifidus muscles so important is the fact that they are spinal stabilizers. Destroying the nerve that controls them can lead to degenerative changes in these muscles, leading to spinal instabilities.
The United States government initiated a clinical trial program to study the long-term effects of radiofrequency ablation surgery in 2018. They aimed to recruit patients who would go through the radiofrequency ablation surgery with the hopes of obtaining post-surgical MRIs several months after the operation. Unfortunately, as of 2020, there has not been any updated news on the clinical trial status.
Therefore, we discourage the RFA (radiofrequency ablation) procedure for facet hypertrophy or facet mediated pain until published studies confirm their effectiveness through serial MRIs (Pre and post-surgery MRI assessments) of the treated area. Post-surgical MRI assessment for radiofrequency ablation is essential. It provides a unique insight into potential damage this procedure will likely cause to the multifidus muscles or the surrounding soft tissues near the spinal joint. As such, we encourage you to opt for alternatives to spine surgery, including radiofrequency abaltion.
Physical Therapy, Chiropractic& Physiotherapy Are The Best Treatment Options For The Spine
If you have facet hypertrophy, you need our treatments. In our centers, we provide targeted integrative non-surgical therapies. Our doctors of chiropractic and clinical physiotherapists or physical therapists always treat our facet hypertrophy patients collaboratively. The goals of our treatment are to stabilize your condition by fixing the root –causes. Earlier, we mentioned that facet hypertrophy is always the result of degenerative changes in spinal discs and spinal joints.
To recover from facet hypertrophy, you will need comprehensive treatment options that address spinal disc issues and facet arthritis, osteophytosis, and spurs collectively. Any form of treatment that fails to address these issues holistically fails. It is just that simple. In short, you need treatments from experts that can address spinal disc issues, muscle issues, ligament issues, and joint and nerve issues during your therapy session. Call or visit us today to get the best back pain treatment in Malaysia.
Opt For The Best Collaborative Treatments From Clinical Teams That Use Spine Specific Technology For Faster Repair?
Chiropractic is excellent but ineffective in addressing all these issues holistically as a standalone system of care. The same holds for physical therapy and physiotherapy. Physical therapy and physiotherapy are often used interchangeably to mean the same. However, there are some differences. In physical therapy, the procedures rendered are manual or hands-on methods provided to patients. Physiotherapy, on the other hand, is procedures given through devices and equipment.
Chiropractic is provided through manual or mechanical means. Some chiropractors use manual methods, while others use mechanical systems or devices to treat patients. Our chiropractors use manual, automated, and machine-delivered methods of chiropractic treatments. Flexion/Distraction Therapy (FD-3000™ or Cox) and Intersegmental Traction are excellent examples of apparatus or modality-assisted chiropractic devices. We are the best chiropractic and physiotherapy center in Malaysia. To conclude this section, Chiropractic Specialty Center® offers patients with neck pain, back pain, slipped disc, hypertrophy of ligamentum flavum, or facet hypertrophy a better method of conservative treatment.
Should You Opt For Spine Surgery For Facet Or Spinal Joints?
There are numerous methods of spine surgery for a hypertrophic facet or a hypertrophied facet. Regardless of type or level of invasiveness, they all fail in the long term. Spine surgery for facet hypertrophy is an option best avoided. You will do better with conservative treatments. The best conservative treatment for a hypertrophic facet is NSD Therapy®, which we shall discuss later. First, let’s provide you information about surgical options that a spine surgeon may offer.
Intra-articular spacers, facet spacers, or interlaminar spacers are relatively new procedures for patients with degenerative facet conditions. These are implants that are screwed into your spinal bones.
The goal is to decompress the facets by separating them apart with an implant. Although some degree of relief can be attained, they are short-term gains. Implants that force the spinal joints to a fixed position accelerate degenerative changes in healthy segments. In short, you could end with more pain and misery after a facet spacer implant is installed in your spine. Patients with a facet spacer often undergo additional surgical intervention. The most common surgical intervention post a facet spacer implant is removing facet spacer, laminectomy, and spine fusion.
Spine Surgery On Facet Hypertrophy
Laminectomy and spinal fusions are also recommended for degenerative facets (hypertrophic facets or facet hypertrophy). Laminectomy is a surgical procedure that involves cutting the lamina. The lamina is the bony projection in the back part of the vertebra that gives rise to the facet. Fusion is just that, fussing of joints and bones together. To conclude, spine surgery has failed to offer lasting relief for facets.
The failure is not your surgeons’ failure, but the fact that in facet degenerations or hypertrophy, there are many factors involved: which cannot be solved through invasive spine surgery.
NSD Therapy® Is Your Best Treatment Option For A Hypertrophic Facet (Degenerated Spine Joint)
We mentioned earlier that NSD Therapy® was the best means of treating your facet joint and spine. NSD Therapy®(CSC’s decompression therapy) is the most comprehensive non-invasive treatment option for a slipped disc, degenerative disc disease, sciatica, spinal canal stenosis, bone spurs, or facet hypertrophy.
Chiropractic Specialty Center® is the only center enabled to offer NSD Therapy®. NSD Therapy®’s treatment program includes physical therapy, chiropractic, physiotherapy, rehabilitation, nutrition supplements, exercise, and much more.
Treatments provided through NSD Therapy® protocols can include:
- Manual physical therapy
- High-Intensity Laser Therapy (HILT)
- Soft-tissue manipulations
- Osseous mobilization
- Trigger point therapy
- Shockwave therapy
- Interferential current therapy
- Flexion-Distraction therapy
- Chiropractic treatment
The goals of NSD Therapy® are to correct and stabilize damaged or injured muscles, ligaments, joints, and spinal discs. A hypertrophied facet results from degenerative changes in muscles, ligaments, joints, and spinal discs. Therefore, recovery is dependent on the accuracy and specificity of the treatments provided. In short, NSD Therapy® provides relief and even corrections for slipped disc (slip-disc) and facet hypertrophy better than any other means of treatment.
At CSC, your clinical teams of chiropractors work in connection with top-rated physiotherapists to fix and repairs the damaged facet joints in facet hypertrophy. Contact one of our centers today for holistic facet hypertrophy treatment without injections or surgery!
This Post Has 2 Comments
I have spinal stenosis on L4 L5. My feet are numb, and I have calf pain when walking.
I have done the injection at SJMC (Subang Jaya Medical Centre) but refuse to get the recommended surgery.
Dear Khoo KS,
First and foremost, please accept our sincere apology for not replying sooner. Our centers were locked down during MCO and have just reopened recently. You mentioned having and L4-L5 spinal stenosis. Spinal stenosis is common in patients with moderate slipped discs, ligamentum flavum hypertrophy, and facet hypertrophy. These three conditions are the leading cause of spinal stenosis. The good news is that spinal canal stenosis is treatable without surgery. We have successfully treated thousands of patients with spinal stenosis and hope to be able to do the same for you. The first step towards a non-surgical recovery is a full assessment. An assessment is needed to identify the main culprit causing stenosis.
The consultation process at one of our centers includes past medical history, neurological assessment, orthopedic assessment, and review of your diagnostic imaging. Therefore, you should bring in your x-rays & MRIs (diagnostic imaging). We will establish your treatment plan after we have completed your assessment. You will be given options and made aware of your non-surgical treatment options, such as NSD Therapy®. NSD Therapy® is the best alternative to spine surgery for slipped disc and spinal stenosis.
We have seven centers throughout the Klang Valley. I encourage you to visit one of our centers for a detailed consultation. Alternatively, you may call our main center at 03 2093 1000 or WhatsApp us on 017 269 1873.
I hope this helps.