I’ve read thousands of magnetic resonance imaging (MRI) reports. An MRI is imaging that is different than x-rays or CT scans. MRI’s show soft tissue problems such as bulging discs, herniated discs, degenerative disc disease, spinal stenosis, osteophytes (bone spurts), and a condition called facet joint hypertrophy.
Most of the MRI reports that come across my desk are lumbar and cervical MRI’s. Occasionally, I’ll read a thoracic MRI report but most of my patients have severe and chronic low back pain with accompanied hip or leg pain.
I’ve also treated many severe neck pain patients with upper extremity radiculopathy which is pain, tingling, numbness or weakness in the upper back, shoulders, arms and hands.
I am going to begin by explaining a little about the anatomy of the spine. I believe that it is important to have a grasp on the basics before you can understand deeper concepts.
What are Facet Joints?
In the spinal column, there are vertebra that combine to make up a spinal segment. A spinal segment has two vertebra and one disc. The disc provides cushion between the two vertebrae.
Each spinal segment has 2 facet joints (right and left) on the back of the vertebrae. Facet joints are considered synovial joints which means that they have a fluid filled capsule that surround them kind of like a fluid filled balloon.
The “synovial fluid” and cartilage in the facet joints serve as a system for the joints to smoothly glide back and forth or side to side. It’s when the cartilage breaks down or the fluid dries up that people will often notice pain or discomfort.
A common finding on MRI reports is a condition called facet joint hypertrophy. Facet joints are in the spine. I know that this can be confusing because some MRI reports refer to the facet joints as the zygapophyseal or apophyseal joints.
It can be really confusing when you try to read an MRI report unless you have a degree in healthcare so I’m going to try to break it down and keep it as simple as possible.
What is Facet Joint Hypertophy?
Simply put, facet Joint hypertrophy is a form of arthritis. In Latin, hypertrophy means enlarged. The facet joints bear the weight in the spine. Over time and years of wear and tear, the facet joints can lose some of their cartilage or simply dry up.
When this occurs, the joints can start to rub or grind on each other and get inflamed. Grinding causes friction which can also produce inflammation and heat.
The internal response created by increased friction can initiate chronic inflammatory processes that can break down the joint complex much faster than what would normally occur with a healthy joint complex.
One of the body’s natural responses to inflammation is to lay down calcium and form new bone. An example of this would be a broken or fractured bone.
What is the Difference between Acute and Chronic Inflammation?
A fracture creates what is called acute inflammation. With acute inflammation, there will be an immediate response such as swelling, pain, a histamine response initiated by the immune system, and a localized temperature increase.
Acute inflammation in bone tissue causes an army of osteoblasts to go into action to make new bone to heal the damaged area. Osteoblasts are the cells that make new bone tissue.
It is well known that a fractured or “broken bone” is usually considered “healed” within 4-6 weeks. That is because the trauma is severe and the inflammatory response is so extreme. Therefore, the healing response is much faster with acute inflammation when compared to chronic inflammation.
Chronic inflammation shares similar responses except that it is much slower and lower grade. Chronic inflammation of tissues can cause degenerative “arthritic” changes can take place over decades instead of weeks.
I explain chronic inflammation to my patients as something that is very slow – similar to stalactites and stalagmites in a cave. They don’t show up overnight and when they are there, you know it’s been a long process.
Therefore, an MRI that shows findings such as facet joint hypertrophy, ligamentum flavum hypertrophy, osteophytes, or uncovertebral joint hypertrophy is an MRI that tells you that the findings are old and driven by chronic inflammatory processes instead of acute inflammation.
Do Facet Joint Injections Work for Facet Joint Syndrome?
People who suffer from facet joint syndrome primarily suffer from either chronic neck pain or chronic low back pain. Often, Drs. trained in conventional medicine will recommend facet joint injections as a method of relieving neck or low back pain caused by facet joint syndrome.
I believe that understanding the underlying cause of why the facet joints became inflamed to begin with and doing something about the unhealthy disc space that is allowing the facet joints to be jammed and inflamed is the safest and best approach.
Facet joint injections are considered a minimally invasive procedure but, they are still invasive. There are risks such as infection, excessive bleeding, nerve damage, paralysis, etc… that some people will experience even from something as simple as a steroid injection.
Also, steroids have many possible side effects and can cause tissue damage. I work with my patients to try to improve the health of the tissues.
Does Facet Joint Hypertophy cause Low Back Pain?
In working with thousands of low back pain patients, it is my experience that people who have low back pain especially while sitting down most likely either have some level of facet joint hypertrophy or at least inflammation of the facet joints.
The reason for this is the back side of the spine (where the facet joints are located) bears the majority of the weight when seated. When the joints are arthritic or inflamed, sitting can aggravate the facets and cause pain.
Some of my patients will have advanced facet joint hypertrophy and arthritis but not have any pain at all when they sit down. Many of them will have pain with prolonged standing or walking instead which is a sign of an unhealthy or degenerative disc space.
When the disc (cushion) between the vertebrae break down and become unhealthy, the facet joints can get jammed and irritated. If jammed over a long time period, then they can go through the chronic degenerative inflammatory processes I discussed above and will usually lead to pain while sitting as the facet joints break down.
Does Facet Joint Hypertrophy Cause Sciatica?
Sciatica is a painful condition caused by pressure on nerves that run into the legs. The nerves that can cause sciatica exit the lower lumbar spine and mainly come out of the spine at the L3, L4, and L5 spinal levels.
Sciatica can be caused by various health conditions such as a tight, bifurcated, or hypertrophied piriformis muscle. In this instance, the sciatica is being caused by a condition known as piriformis syndrome.
If the disc space is in poor health or degenerated, enlarged facet joints can pinch or compress the sciatic nerve and cause horrific sciatica pain into one or both legs.
I’ve helped countless sciatica patients. I work with sciatica from a tissue approach and strive to improve the health of the degenerative disc, a herniated disc, or a bulging disc.
Does Facet Joint Hypertrophy cause Neck Pain?
I’ve worked with and helped thousands of chronic neck pain sufferers over my 17 year career. Pain is what brings patients to me. They come because of their pain but there are usually other signs or symptoms that they are dealing with as well as their pain.
A common sign of facet joint hypertrophy in the neck is decreased range of motion, popping, cracking, grinding, and clicking with head rotation. So, if you hear popping or grinding in your neck, you may have some degenerative disc disease with accompanying facet joint hypertrophy.
I’ve often said that if there is degenerative disc disease with accompanying facet joint hypertrophy in the neck, there is probably some degenerative disc disease in the low back as well.
If your low back had ears, you would probably hear the same popping and grinding sounds coming out of your low back as your neck. It’s one spine and therefore, the whole spine shares the burden of poor health, traumas, etc… If there is smoke, there is fire.
My neck patients often tell me that some of the first benefits of treatment that they see are: easier and better range of motion, less popping or grinding sounds, and better sleep quality.
My treatment methods are non-invasive and unique. They have a high success rate and have changed many lives. People have traveled from around the globe to receive my care. Don’t suffer needlessly. Help could be a phone call away.
Health is Happiness,
Dr. Keith Currie