What is Facet Arthropathy?
Facet arthropathy is a type of arthritis that affects the facet joints, which are small joints located at the back of each vertebra in your spine. These paired joints connect the vertebrae, allowing for movement while also providing stability. As with other joints in the body, the facet joints are lined with cartilage and surrounded by a joint capsule containing lubricating synovial fluid. Over time, due to natural wear and tear, trauma, or other factors, this cartilage can break down. This leads to inflammation, friction, and the development of bone spurs (osteophytes), a condition known as facet arthropathy or facet joint syndrome. While the condition can occur anywhere along the spine, it is most common in the lumbar (lower back) and cervical (neck) regions.
The “Average” Age: A Look at the Data
Instead of a single average age, research reveals a progressive increase in the prevalence of facet arthropathy with age. In one notable study examining cadaveric lumbar spines, evidence of arthrosis was found in over half of adults in their 20s and in a full 100% of those over 60 years old. This means that while symptoms might not appear until mid-to-late adulthood, the degenerative process itself begins much earlier and is a normal part of aging. Therefore, while older adults between 40 and 70 are most commonly affected by symptomatic facet arthropathy, it is not a condition limited to a specific age range but rather a reflection of the spine's cumulative history.
Risk Factors That Accelerate Facet Arthropathy
Several factors can hasten the onset or progression of facet arthropathy, influencing when an individual might experience symptoms. Age is the most significant factor, but it is not the only one. Understanding these risks can help in managing symptoms and potentially slowing the condition's development.
Lifestyle and Hereditary Factors
- Genetics: A family history of osteoarthritis can increase a person's predisposition to developing facet arthropathy.
- Obesity: Excess body weight, particularly in the midsection, puts additional strain on the lumbar facet joints, accelerating cartilage wear. Studies have shown a strong correlation between higher Body Mass Index (BMI) and increased risk.
- Poor Posture: Incorrect posture, whether sitting or standing, can misalign the spine and place uneven pressure on the facet joints over time.
- Sedentary Lifestyle: A lack of physical activity can weaken the core muscles that support the spine, leading to increased stress on the facet joints.
Trauma and Repetitive Stress
- Injury: Trauma from an accident, such as a car crash or a fall, can directly damage the facet joints.
- Repetitive Motions: Occupations or sports involving repeated bending, twisting, or lifting can put excessive strain on the spinal joints.
- Degenerative Disc Disease: As the intervertebral discs lose height and hydration, more stress is transferred to the facet joints, causing them to wear out faster.
Diagnosing Facet Arthropathy
Diagnosing facet arthropathy typically involves a multi-pronged approach, as imaging alone is not sufficient. An individual's symptoms and physical examination findings are crucial in determining if the facet joints are the source of pain. The diagnostic process often includes:
- Medical History and Physical Exam: A doctor will inquire about the location and nature of pain (e.g., worse when twisting or bending backward). They will also perform a physical exam to check for tenderness over the affected joints and assess range of motion.
- Imaging Studies: X-rays, CT scans, and MRI scans can all provide visual evidence of degenerative changes, such as bone spurs or joint space narrowing. However, these changes can be present in asymptomatic individuals, so they must be correlated with clinical findings.
- Diagnostic Injections: A medial branch block, where a local anesthetic is injected near the nerves that supply the facet joints, is often the most definitive diagnostic tool. If the injection significantly relieves the pain, it confirms the facet joint as the pain source.
Treatment and Management Options
Managing facet arthropathy focuses on relieving pain, reducing inflammation, and restoring function. The approach can range from conservative care to more invasive procedures. The choice of treatment depends on the severity of the condition and the patient's individual needs.
| Treatment Type | Examples | Description | Efficacy | Timeframe | Notes |
|---|---|---|---|---|---|
| Conservative | Physical Therapy, Medication, Heat/Ice | Focuses on strengthening supporting muscles, improving posture, and using NSAIDs to manage inflammation. | Often effective for mild to moderate symptoms. | Ongoing | Long-term management; requires patient commitment. |
| Interventional | Facet Joint Injections, Radiofrequency Ablation (RFA) | Injections deliver corticosteroids directly to the joint for inflammation, while RFA uses heat to lesion pain-transmitting nerves. | Injections offer temporary relief; RFA can provide longer-lasting relief (6-12 months). | Periodic | Typically considered when conservative care fails. |
| Surgical | Spinal Fusion, Decompression | Reserved for severe cases, often when arthropathy leads to spinal instability or nerve compression (e.g., spinal stenosis). | Generally a last resort; aims to stabilize the spine. | Permanent | Involves significant recovery time and risks. |
Can Facet Arthropathy Lead to Other Spinal Problems?
Left unmanaged, facet arthropathy can contribute to or exacerbate other spinal conditions. As the facet joints enlarge and develop osteophytes, they can encroach upon the spinal canal and nerve roots, potentially causing spinal stenosis or radiculopathy. Furthermore, the loss of stability can lead to spondylolisthesis, a condition where one vertebra slips forward over the one below it.
Conclusion
While what is the average age for facet arthropathy has no single answer, it is clear that it is an inevitable part of the aging process for many. Symptomatic disease most commonly presents in middle age, with prevalence increasing significantly with each passing decade. However, through proactive measures like maintaining a healthy weight, regular low-impact exercise, and proper posture, it is possible to mitigate the impact of this condition. For those experiencing pain, a range of diagnostic and treatment options exists, from conservative physical therapy to advanced interventional procedures, all aimed at improving quality of life and managing symptoms. Finding an effective management strategy is key to living well with an aging spine. For more detailed information on spinal disorders and treatment options, you can consult reputable medical resources, such as the Hospital for Special Surgery's health library.
