Osteoarthritis of the Spine is Very Common
As a Pain Management physician, back arthritis is one of the most common problems I treat. Although there are different types of arthritis, we’ll be focusing on the most common type, osteoarthritis, here today. Osteoarthritis is commonly referred to as “wear and tear” arthritis and can affect the low back in up to 85% of people throughout their lifetime.
As you’d imagine, I see a number of patients on a daily basis who suffer from chronic pain that stems from back arthritis. Before we can understand the available treatment options for someone suffering from this type of pain, let’s take a deeper dive and get to know more about spinal anatomy.
Anatomy of the Spine
The spine is made up of vertebrae that form a protective canal for your spinal cord and exiting nerve roots. The front of the spine contains the round vertebral bodies that are separated by intervertebral discs that serve as your shock absorbers. A boney ring is then formed along the mid portion of the spine to a create a channel for the spinal cord and nerve roots to travel.
Anatomy of the Facet Joints
The back of the spine is made up of tiny joints called “facet joints” that serve as points of articulation. Not only do they protect the spinal cord and nerve roots, but they function to allow bending and twisting of the spine. These joints are made up of superior and inferior articular processes, as depicted in the image above, that are lined with hyaline cartilage, a slick spongy-like material that allows the bones to glide over one another without much friction. They are surrounded by a water-tight, ligamentous casing, known as a joint capsule, that contains synovial fluid which works to keep the surface of the facet joints lubricated. Think of synovial fluid like motor oil for your facets which helps to reduce friction.
Nerve Supply to the Facet Joints
The facet joints are innervated by small nerve fibers known as medial branches. This is important to mention as these nerve fibers can be targeted in some of the treatment options mentioned below.
Causes of Facet Arthritis:
Biomechanical Abnormalities: Back arthritis, also known as facet arthropathy, can develop due to a number of reasons. There can be abnormal biomechanical stressors due to muscular imbalance, inflexibility, and poor posture that cause increased pressure on the facet joints resulting in arthritic changes over time.
Degenerative Disc Disease: Degenerative disc disease can also cause facet arthritis as the discs dehydrate, lose disc height, putting increased stress on the facets. As a protective mechanism, the facet joints hypertrophy, or increase their size, due to repetitive stress resulting in arthritic changes.
Trauma: Blunt force trauma or repetitive microtrauma can cause the facets to become arthritic. Unfortunately, this is true for most joints in your body. This is also why it’s important to focus on exercise routines that are easier on the joints such as cycling and swimming.
Obesity: As you’d imagine carrying around extra weight puts increased pressure on the spine and all the joints of the body for that matter. When there is increased joint stress on a regular basis, this predisposes one to the development of arthritic changes.
Inflammatory Processes: Inflammatory processes like rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis can cause arthritic changes to occur in the facet joints, but typically this is via a different mechanism than your typical osteoarthritis.
What can we do About Back Arthritis?
A) Prevention is Key
Fortunately, facet joint degeneration doesn’t happen overnight. Typically, it takes decades to develop. This is why we commonly see this pathology in older populations. The good news is, we can all make changes to help slow it’s progression, or prevent the problem altogether.
We can do this through lifestyle changes that you can start making today. Take the steps necessary to maintain a healthy weight. Eat primarily a plant-based, whole food, unprocessed diet and you’ll be amazed how quickly the lbs come off. This change alone comes with a slew of other health benefits as discussed in a previous post entitled, 5 Reasons to Try a Plant-Based Diet.
Exercise regularly to maintain a healthy core. Remember your core isn’t made up of just your abdominal musculature-there are a number of deep paraspinal muscles in the back that are equally as important. For more information on this, check out our post entitled, Don’t Just Work Your Glamour Muscles.
B) Stop Smoking
Smoking is linked to increased incidences of degenerative disc disease as the fine capillary network feeding the intervertebral discs are destroyed. When this occurs, your discs become dehydrated, fibrotic, and lose height. This puts increased stress on the facet joints predisposing you to early arthritic changes. Not to mention, it’s costing you an arm and a leg as discussed in this post, Smoking one Pack of Cigarettes per day is Costing you 50k.
Treatment Options for Relieving Pain
Fortunately, if you do develop pain from facet arthritis there are a number of treatment options available to you. These include:
As with all the content in this blog, you should discuss these options first with your medical doctor before implementation as all treatment options might not be appropriate for each individual. How about you? Do you suffer from back arthritis? What treatment options have worked well for you? Which haven’t?
References:
Rights to use above images were purchased from: https://aneskey.com/facet-joint-procedures-facet-joint-injections-medial-branch-blocks-and-radiofrequency-ablation-of-the-medial-branches-of-the-spinal-nerve-roots/