WHEN TO SEE A SPINE SPECIALIST

You should seek the advice of a spine specialist if neck or back pain persists for more than two weeks or if it is progressive in intensity and/or distribution. You should seek immediate healthcare attention if neck or back pain occurs as the result of an injury or if it is associated with serious illness and/or a high fever. Additional signs and symptoms which warrant prompt medical attention include:

• Neck or back pain associated with bowel and/or bladder dysfunction
• Neck or back pain associated with extremity weakness or difficulty with coordination
• Extremity numbness or muscle weakness
• Neck or back pain that is associated with impaired walking (gait) or difficulty with balance
• Numbness, tingling and/or muscle weakness associated with a back or neck injury

SCREENING AND DIAGNOSIS

Facet arthropathy may be associated with a facet syndrome. The term syndrome refers to a constellation of signs and symptoms characteristic of an underlying disorder. The diagnosis of a facet syndrome is often made based upon the patient’s personal history and physical examination findings. There are a number of different orthopedic tests which help confirm the presence of abnormal spinal segment movement and/or inflammation involving a facet joint. Plain films or regular X-ray are adequate for demonstrating the presence and severity of degenerative facet changes.

The most common features on X-ray include overgrowth of the bone of the facet (bone hypertrophy) and erosion of the facet joint cartilage resulting in joint space narrowing. Facet arthropathy is often accompanied by spondylosis, a condition referring to degenerative related boney changes including spurring of the adjacent vertebrae. Advanced imaging such as CT and MRI can be particular helpful. On CT there are characteristic boney changes involving the facet joint.  They often assume a mushroom cap appearance. There is often some thickening of bone under the degenerative cartilage a process called sclerosis. MRI reveals more information about the soft tissues of and around the facet joint. Like CT, MRI will reveal joint space narrowing. Some patients will show thickening of the synovium (joint lining) and the joint capsule. MRI is good for assessing compromise of adjacent neurological structures such as the spinal nerve and the spinal cord.

Spinal disorders which may present similarly to facet arthropathy which may have to be ruled out include a healing facet fracture and various other inflammatory joint disorders. This includes:

• Rheumatoid arthritis
• Ankylosing spondylitis
• Psoriatic arthritis
• Reiter’s disease
• Gout

Your attending healthcare provider may have to order lab work and imaging studies of other body areas to help determine if you have one of these forms of arthritis. More than one form of arthritis can be present with degenerative facet arthropathy.