Symptoms of Cervical Degenerative Facet Disease
Facet degeneration or arthrosis causes four potential symptoms; neck pain, headaches, arm pain from foraminal stenosis (compression of the nerve root) and instability pain (degenerative spondylolysthesis with potential spinal cord compression).
Local neck pain is probably the most common symptom of facet pain. When the cartilaginous surfaces wear off and bone to bone contact is the result, deep dull local bone ache is common. Sharp pain with movement occurs when neck motion overloads these surfaces. Stiffness and joint noises (clicking and popping) typically occur. This pain can radiate into the shoulders.
The upper cervical joints (C2-3 and C3-4) can cause headaches along with local pain due to their proximity to two particular nerves; the greater occipital nerve-C2 and the lesser occipital nerve- C3 (AKA greater auricular nerve). The greater occipital nerve originates from C2 and radiates up over the skull to end at the forehead. The lesser occipital nerve originates from C3 and radiates around the ear to the temple. These two nerves can cause suboccipital headaches (headaches that originate from the base of the skull and radiate to their respective terminus). Interestingly, the C2-3 and C3-4 facets do not have to have significant degenerative appearances on MRI or CT scan to cause this type of pain.
Facets develop bone spurs when they become arthritic. These bone spurs can grow into the foramen and compress the spinal nerve (pinched nerves). This in turn will cause pain that radiates down the distribution of the nerve. Each nerve has a specific route of pain that will be produced. If the C3 nerve is involved, pain will radiate from the base of the skull around the ear and terminate at the temple. If the C7 nerve is involved, pain will radiate from the shoulder into the middle of the hand. This condition is covered more thoroughly in the foraminal stenosis section on this website.
Many times, arthritic facets will not be painful even with advanced arthritis. However, the wear of the facets will allow some increased play in the “doorstop mechanism”. This sloppiness can allow a forward slip of one vertebra on the other and will increase the strain on the disc. This, in turn can lead to annular tears of the disc, which then starts the degenerative cascade of degenerative disc disease. In addition, the wear of the facets can allow a forward slip of the vertebra above on the vertebra below leading to a degenerative spondylolisthesis. This shifting can cause local neck instability pain or can cause intermittent compression of the nerve roots or even spinal cord compression.
Treatment of Cervical Degenerative Facet Disease
Treatment of facet disease depends upon the symptoms, the biomechanics and the source of pain. There are many individuals that have facet disease without pain. The reason for the lack of pain in some individuals while others have incapacitating pain is a Nobel Prize winning answer.
Simple facet pain responds to many therapies including chiropractic, physical therapy, massage and even acupuncture. For more advanced pain that fails these treatments, injection therapy in the form of facet blocks or medial branch blocks (see website under injections for more information) can be effective.
Rhizolysis (the burning of the small sensory nerves that innervate the joint through a small needle) can be very effective in the right hands under the right circumstances.
Finally, surgery can be very effective. If a pinched nerve develops from facet arthritis, a posterior foraminotomy can be effective (as long as there is also no anterior bone spur off the uncovertebral joint). For instability from a degenerative spondylolisthesis or from severe pain due to a very arthritic facet, fusion is required. Artificial discs will not work in this circumstance.
To discuss cervical degenerative facet disease in more detail, please contact the office of Dr. Donald Corenman, spine specialist and neck doctor serving the communities of Vail, Aspen, Denver and Grand Junction, Colorado.