Oh, my aching back! Understanding spondylolisthesis and Facet Joint Syndrome

Spondylolisthesis and Facet Join Syndrome are two back conditions that affect the spine in different ways. Both conditions, if left untreated, can have a significant impact on a patient’s quality of life.

Spondylolisthesis and Facet Join Syndrome are two back conditions that affect the spine in different ways. Both conditions, if left untreated, can have a significant impact on a patient’s quality of life.

What is Spondylolisthesis?
Spondylolisthesis is a condition in which one of the vertebrae in the spine slips out of place, shifting over the bone below. In most cases, this condition affects the lumbar or lower spine. Patients with spondylolisthesis do not always have symptoms. But because the joints and nerves can be pinched when a vertebra is not in the proper position, some patients suffer low back pain, muscle tightness or weakness, sciatic leg pain and numbness or tingling in the thighs and buttocks. Over time, lordosis (swayback) or kyphosis (roundback) can develop as a result.

What Causes Spondylolisthesis?
Children may be born with thin vertebral bone or defective joints. Consequently, these individuals are more susceptible to bone slippage over the course of their lifetimes. When this condition occurs in children, it may be related to a birth defect in that portion of the spine.
Spondylolisthesis in adults is typically the result of aging. Genetics may play a part in some cases or abnormal wear and tear on the bones and cartilage, such as from arthritis. Bone problems, such as osteoporosis or low bone density, also may be contributing factors.
Sudden injury or trauma to the spine can also cause spondylolisthesis. More often, however, stress fractures caused by repeated use over time are responsible. Participating in sports activities that stress the spine, including gymnastics, football and weight lifting, can increase the risk of suffering spondylolisthesis or cause the condition to worsen.

How is Spondylolisthesis Diagnosised?
A medical history and physical exam are the first steps to diagnosing spondylolisthesis. The sports and spine specialist will observe the patient’s posture and range of motion and test reflexes and muscle strength. The doctor will also order X-rays to determine if a vertebra has slipped.

To see how the bone moves, it may be necessary to take X-rays of the patient while he or she is bending forward and backward. To confirm a spondylolisthesis diagnosis, a CT scan or MRI also may be ordered.

How is Spondylolisthesis Treated?
Treatment for spondylolisthesis depends upon the severity of the vertebra slippage, but many patients are able to find symptomatic relief through conservative measures.

Physical therapy exercises may be recommended to stretch and strengthen the muscles of the lower back. In some spondylolisthesis cases, the sports and spine specialist may also recommend avoiding contact sports for a period of time or wearing a back brace to limit spine movement.

For pain relief, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are often recommended. For persistent or severe pain, epidural steroid injections may be considered.

If conservative treatments are unsuccessful at reducing the symptoms of spondylolisthesis or if the vertebra slippage progressively worsens, surgery may be needed. A procedure may be performed to relieve pressure on the nerves. Or, if no other treatment can provide relief from spondylolisthesis, the orthopedic surgeon may perform a spinal fusion to maintain the vertebrae in the proper position.

What is Facet Joint Syndrome?
Facet Joint Syndrome is a condition that causes pain, inflammation and stiffness in the facet joints of the spine. Also called the zygapophyseal or z-joints, these structures allow the vertebrae of the spine to bend and move. Patients affected by facet disease often walk hunched over, as damage or degeneration in these joints can make it difficult to stand up straight. Many patients also have trouble looking left or right without turning their entire body.

Facet disease may be a factor in up to 40 percent of patients with chronic lower back pain. In addition, the z-joints are likely involved in most cases of mechanical back pain, or pain that arises from the spinal structures.

What Causes Facet Joint Syndrome?
General wear and tear as a result of aging is a common cause of facet disease. Repetitive stress to the z-joints can cause degenerative changes that affect how the spine is able to flex and twist. Osteoarthritis of the spine also can cause pain and swelling in these joints, resulting in issues with mobility and range of motion.

Athletes and those with physically demanding jobs requiring frequently performing repetitive spinal maneuvers, are susceptible to traumatic injury or damage to the z-joints. Certain risk factors, such as excess weight, poor posture, and tobacco and alcohol use, may contribute to the development of this condition.

Facet Joint Syndrome Diagnosis
Diagnosing facet disease begins with a detailed medical history along with a review of the patient’s symptoms. The physician will perform a physical examination to determine the location and extent of pain as well as any limitations in spinal movement.

Because facet disease can mimic many other back conditions, diagnostic tests may be ordered to rule out other potential causes of pain and inflammation. X-rays are typically the first step, though a bone scan, CT scan or MRI also may be recommended. To confirm a diagnosis, the physician may inject an anesthetic into the z-joint. If this results in the immediate reduction of back pain, facet disease is determined to be the cause of the patient’s symptoms.

How is Facet Joint Syndrome Treated?
Conservative treatments are recommended for the first attempts at treating facet disease. Physical therapy may be advised to correct bad posture and re-establish a normal range of motion. The doctor may recommend non-steroidal anti-inflammatory drugs to reduce swelling, while over-the-counter pain medications and muscle relaxers may be taken to manage other symptoms.

When a diagnostic facet joint injection is performed, the doctor may also inject a steroid medication to provide long-term relief from back pain. Or, if one of the nerves that transmits pain signals to the joint is the source of the problem, a nerve block or radiofrequency ablation may be performed to interrupt the nerve’s signals and relieve pain.

If conservative measures are not successful in treating the symptoms of facet disease, surgical intervention may be necessary. Minimally invasive procedures will be considered first, though some patients may require open spine surgery.

Dr. Robert Engelen is a sports medicine and spine specialist practicing with Neuroscience & Rehabilitation Specialists in West Jordan.