As an integral component of your spine, facet joints can sometimes be a source of pain. Facet hypertrophy (sometimes called facet joint hypertrophy) is an extremely common—and sometimes painful—condition. In this article I’ll define facet hypertrophy, explain what causes it, and discuss what you can do to relieve your symptoms.
What is facet hypertrophy?
As the name implies, facet hypertrophy is a condition that stems from your facet joints. Your spine is a series of stacked vertebrae or vertebral bodies, each containing a disc and two facet joints, connected by ligaments and muscles. Healthy facet joints have cartilage, allowing smooth and painless movement.
Sometimes, when there’s a mechanical overload or dysfunction of the joint, the cartilage starts to wear away, causing abnormal motion. In an attempt to minimize the abnormality, your body responds by trying to stiffen the facet joints, building up calcium deposits along the edges of the bone joint. These calcium deposits are called bone spurs, and they cause the facet joints to become enlarged. (The word hypertrophy means “enlargement.”) When that happens, they start to take up space where the nerves are traveling, which ultimately leads to nerve compression and spinal stenosis.
In rare cases this calcium buildup occurs on just a single facet joint; it more typically occurs on both and is called bilateral facet hypertrophy. However, it may be more severe on one side.
Facet Joint Hypertrophy Caused By Disc Abnormality
Disc and facet joints work together as a unit, similar to the ball and socket of your hip, to help your bones glide easily across each other for smooth body motions. A problem with one component will impact the other; in the spine, that eventually leads to back and leg pain.
In the case of facet hypertrophy, the problem is caused by enlarging facets, but this rarely occurs as an isolated event; it is almost always associated with some abnormality of the disc. When the disc itself experiences early degeneration, it can no longer carry its normal mechanical load. In a healthy vertebrae, the disc carries 80 percent of the load, while the facet joints carry 20 percent. Depending on the severity of the degeneration, a worn-out disc may only carry 60 or 70 percent of the load, while the facet joints make up the difference. Eventually, the facets may carry an even greater load than the disc, a condition that wears down the cartilage and leads to bone spurs.
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In some ways, the relationship between facet hypertrophic changes and disc abnormality is a little bit like the chicken or the egg debate—does the initial mechanical abnormality start with the disc and then transfer to the facet, or is it the other way around? Most cases start with a degenerating disc, but because the disc and facets are so tightly intertwined, the facets are soon affected.
What brings on disc degeneration? It may be either natural causes or a trauma—when a major mechanical load is applied to the disc and causes tearing or a small partial herniation. Either way could lead to a bulging disc, bone spurs on the facet joints, and facet hypertrophy. Ultimately, these conditions combine to compress the nerves and cause pain.
If, for instance, you slam your knee into the dashboard in an auto accident, your knee X-ray may look normal. But an X-ray won’t show the bruised cartilage underneath your kneecap, which may be the reason it starts wearing away a few years later. That’s a post-traumatic form of arthritis, but the end result is the same as degenerative arthritis—pain in your knee.
The same thing could happen in your spine. If you experience a trauma, for example, during a high school sporting event, your X-ray may look normal, and your back pain may even subside after a few days. But it’s possible the trauma to your back caused bruising to your facet joint cartilage. If that happens, that cartilage will start to wear away over a period of a few months to a few years, leading to bone rubbing on bone, inflammation, and bone spurs.
Facet Hypertrophy Treatment
Facet hypertrophy manifests itself as spinal stenosis, the symptoms of which are back and leg pain. Typically it feels worse when you’re standing and walking, and better when you’re sitting.
There’s nothing you can do to reverse facet joint hypertrophy, but there are things you can do to make it less painful:
- Stay active. Exercises that keep the disc and joints mobile can help keep the pain at bay. You can also do activities to build up the muscles around the spine to help reduce the mechanical load applied to the disc and joints.
- Try epidural steroid injections. Steroids injected into the facet joints may help decrease the pain, particularly in the early stages of stenosis. But if your condition is too severe, most doctors will avoid putting needles in an area with so little space.
You can’t prevent ongoing deterioration, so some people who suffer from facet hypertrophy and spinal stenosis will eventually require surgery. But not everyone who gets hypertrophy will need surgery—some will experience stiffness in their back but not a lot of pain. Nerves can tolerate a lot a pressure if it is applied very gradually and slowly, so your condition may not ever be very painful. In fact, fewer than 50 percent of people with spinal stenosis need surgery, and almost everyone over the age of 65 has some degree of mild to moderate disc and facet degeneration.
Surgery For Facet Hypertrophy & Spinal Stenosis
People with more advanced lumbar facet hypertrophy and spinal stenosis may opt for surgery if the condition is interfering with their life, either in terms of necessary mobility or simply enjoying their favorite activities.
Surgery involves “decompression” to remove or address the offending material pressing on the nerves (i.e., removing a bone spur or even taking out some of a diseased disc if need be). Once the material is removed, the surgeon will assess the stability of the spine. More often than not, by removing the bone or disc material, the surgeon will have created an instability (iatrogenic instability).
In the past, the only option for restabilization was fusion. One of the problems with fusion—a surgical procedure that removes the problematic joint—is that taking away the mobility of even a single level in your spine places added stress on the adjacent levels, both above and below the fused location. This often leads to rapid degeneration of one or both levels, which means you’ll likely need another fusion surgery down the road.
But there is another option. The BalancedBack® Total Joint Replacement can be used to restabilize your spine after a decompression for stenosis, instead of fusing the unstable segments with screws, rods, and spacers. The BalancedBack® procedure preserves your mobility by giving you a completely new joint rather than removing a joint. Your new joint replaces the function of both the disc and facet joints, which means there’s no fusion stress placed on the areas above and below the affected level—decreasing the likelihood of repeat surgery.
Also, BalancedBack® uses a posterior approach (from the back), which is safer than surgeries that use an anterior or frontal approach (frontal approaches require surgeons to cut through, around, or near several vital organs to reach the spine). Direct decompression is impossible from the anterior or frontal approach, because stenosis is in the back. Only BalancedBack® allows for complete decompression to unpinch the nerves and relieve stenosis, while restabilizing your spine and restoring your natural range of movement and spinal balance.
Want to know if you’re a good candidate for BalancedBack®?
If your doctor has recommended surgery for your facet hypertrophy and spinal stenosis symptoms, reach out to us to see if you’re a good candidate for BalancedBack®. We’ll provide you with materials you can use to consult with your doctor, and we’ll answer any questions you have about the procedure, the BalancedBack® device, and the surgical experience.