What Is Facet Hypertrophy?

Facet hypertrophy is a common problem that causes the facet joints in your spine to enlarge.

New bone growth and bone spurs can also develop as the joint tries to repair the damaged cartilage. The swelling and new growth can narrow the spinal canal and compress nearby nerves, causing pain. This problem does not have a cure. It gets worse over time. The goal of treatment is to manage pain and slow disease progress.

This article describes facet hypertrophy, its symptoms, causes, diagnosis, and treatment.

Types of Facet Hypertrophy

Facet hypertrophy can be described as unilateral or bilateral. These types differ in that the pain is felt on either one side (unilateral) or both sides (bilateral) of the following areas above the knees:

• Buttocks
• Sides of the groin
• Thighs

Facet Hypertrophy Symptoms

Facet hypertrophy symptoms can occur within a wide range of intensity. Symptoms can vary from a dull ache to chronic, disabling pain. The location of symptoms depends on the location of the affected facet joint and the nerves involved,

Pain occurs when the enlarged facet joints and new bone growth compresses the nearby nerves. The result leads to nerve damage and the following symptoms:

• Burning pain
• Reduced range of motion and mobility
• Muscle spasms
• Muscle weakness
• Numbness or a tingling sensation of pins and needles
• Inability to look up to the left or right without turning your entire body
• Stiffness, especially when standing up straight or getting out of a chair
  
• Inability to stand straight when walking

The following symptoms are specific to the location of the facet joint affected:

• Radiating pain from the affected joint into the buttocks, hips, and upper thigh when the affected facet joints are in the lower back
• Radiating pain from the affected joint into the shoulder, neck, and back of the head when the affected facet joints in the upper back
• Headaches when the affected joint is in the neck
  

Causes

A common cause of facet hypertrophy is the age-related degeneration of the joints between the spine, called spondylosis. The major risk factor for developing spondylosis is age. Spondylosis is a somewhat inevitable consequence of aging.

Research indicates that more than 80% of people who are 40 or older have radiologic evidence of spondylosis, even though they may not have symptoms.

The following conditions can also increase your risk of facet hypertrophy:

• Osteoarthritis
• Injury or trauma to the spine
• Inflammatory conditions like rheumatoid arthritis or ankylosing spondylitis
• Genetic predisposition to the condition
• Sedentary lifestyle
• Poor posture
• Being overweight or obese
  

Diagnosis

Diagnosis of facet hypertrophy can be challenging when neck or back pain is your chief complaint. Symptoms of facet hypertrophy can mimic other conditions, such as sciatica from a herniated disc or hip arthritis.

Your healthcare provider will conduct a complete physical examination, medical history, and discussion of symptoms. As part of the examination, you may be asked to move into positions that cause pain and indicate where the pain occurs.

The following imaging tests can show some aspects of visible damage and inflammation or rule out other injuries or conditions that may be causing your pain.

• Computed tomography (CT) scans with or without myelogram (the use of contrast dye in the space around the spinal cord)
• Magnetic resonance imaging (MRI)
• X-rays with or without a myelogram
  

A diagnosis of facet hypertrophy is confirmed by injecting a diagnostic block. This involves administering an injection of anesthetic, sometimes with an anti-inflammatory like cortisone, into the joint or nerves near the affected joint. Two injections are given at different times to confirm the effect.

If immediate relief improves after each injection, the facet joint is confirmed as the source of pain. If the block does not decrease the pain, the facet joint is probably not the source of your pain.

Treatment

There is no cure for facet hypertrophy. The goal of treatment is to make the pain more manageable. Conservative treatment is usually successful in making a difference.

Conservative Treatment

First-line treatment involves the following conservative therapies:

• Physical therapy to strengthen the core muscles and spine
• Daily prescribed exercises to help you remain flexible
• Good posture habits
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen
• Muscle relaxers like Flexeril (cyclobenzaprine) or Skelaxin (metaxalone)
• injection of a steroid into the facet joints
• Injection of platelet-rich plasma (PRP) into the facet joints
  
• Massage therapy
• Acupuncture
• Bracing to stabilize the spine
  

Medial Branch or Facet Block

A medial branch block injects local anesthetic near the small medial nerves that connect to an inflamed facet joint. Medial nerves are the small nerves outside the joint space near the nerve that carry pain messages and other impulses from your facet joints to your brain.

A facet block injects the medication outside the joint space near the nerve that supplies the joint. This nerve is called the medial branch.

Neurolysis

Neurolysis, also called rhizotomy or neurotomy, is a procedure that destroys affected nerve fibers to achieve pain relief, reduce disability, and reduce the need for analgesics. This treatment can reduce pain for six to 12 months until the nerves regenerate. Further treatments may be necessary at that time.

Neurolysis can be performed using one of the following techniques to destroy the affected nerves through ablation:

• Radiofrequency ablation (the application of heat via radiofrequency)
• Cryoneurolysis (the application of cold to the targeted nerve)
• Chemical neurolysis (the application of chemical agents, often a combination of phenol and alcohol)
• Severing the nerves with a surgical instrument

Surgery

When one or more facet joints are severely damaged, the entire unit can become painful and nonfunctional, Surgery may be used when symptoms of facet hypertrophy are not relieved by other types of therapy.

Prognosis

Facet hypertrophy is a chronic condition that progresses with age. The disorder is incurable, but symptoms often respond well to conservative therapies. Facet hypertrophy does not affect life expectancy.

Your healthcare provider can help you determine a treatment plan based on the extent and location of the facet joint affected. Early diagnosis and treatment can help you achieve the best results.

Coping

Most people can manage the pain of facet hypertrophy with conservative treatment. However, avoiding certain sports and other activities that cause pain may also be necessary. This can allow time for the inflammation to subside.

Maintaining an active lifestyle and healthy weight can help prevent further stress on the joints. You may have to perform regular stretching and strengthening exercises for the rest of your life to lower inflammation, reduce stress, and improve your overall health.

Summary

Facet hypertrophy is an incurable, chronic disease that affects the facet joints in your spine. These joints stabilize your spine when you twist and bend. They are found where two vertebrae come into contact on the back of the vertebrae that form your backbone.

Aging, wear and tear, arthritis, and other joint diseases can damage facet joints. Facet hypertrophy results when damage wears down the cartilage that cushions the two bones that meet in the joint. Swelling, new bone growth, and bone spurs can occur as the joint tries to repair the damaged cartilage. The swelling and new bone growth can compress nearby nerves and cause pain.

This disease worsens over time, though treatment can help you manage pain and slow disease progress. Most cases respond well to conservative treatment. Patients with more severe cases may need nerve ablation or joint replacement surgery.