Lumbar Degenerative Facet Disease

Lumbar Degenerative Facet Disease Overview

There are many factors to consider as to why lower back pain exists. The lumbar facets are the joints in the back of the vertebra that are paired and hook the rear of the top vertebra to the back of the vertebra below. With movement, they are important in guiding the spine to track properly and create normal spinal alignment. The disk in front absorbs shock and dampens motion but it is the facets in back that are important to guide the motion of the vertebra like railroad tracks guide a train (read more Introduction to the Function of the Lumbar Spine).

When it comes to bearing weight, the disc in front carries almost 80% of the weight and the facets only 20%. This weight bearing distribution changes with forward and backward bending. Bending forward causes the disc to bear almost all the load and bending backwards causes the facets to bear almost 70% of the weight of the upper body.

The facets are real joints similar to a hip or knee joint. A joint is essentially a movable surface located where two bones join together. In this type of joint, called a diarthrodial joint, both joining bones have smooth caps of cartilage that covers the surfaces. These facet joints are held together with a strong flat sheet of collagen called a capsule that surrounds the joints. Lining this capsule is the synovium, a thin sheet of specialized cells that make the lubricant- synovial fluid- similar to WD 40 oil.

The joint surfaces are so perfectly matched and smooth that with the synovial fluid, there is a vacuum that holds the joints together. Breaking this vacuum causes a popping sound similar to removing a wet glass from a smooth counter. There is no danger in breaking this vacuum and it can feel quite good, as when a Chiropractor manipulates the spine.

Abnormal movement of the facets, as commonly seen with an associated degenerative disc can cause uneven wear of the cartilage and even cause some of the joint surface to sheer off. The smooth lining of these facets (the cartilage) has a very poor blood supply and cannot heal if injured. “Degenerative facet arthritis” or lumbar “degenerative facet disease” is the term used for the wearing down of the cartilage surfaces in the spine.

The facets mechanically are “door stops”. Looking carefully at a side view of a normal lumbar x-ray, the vertebra all line up perfectly. With lumbar degenerative facet disease, changes of the disc and the height of the disc is lost. The vertebra involved will slide backwards on the one below (called a retrolysthesis) because they are shaped like a ramp facing backwards. However, in spite of a degenerative disc being present, if the facets have worn out and eroded down, the vertebra will slide forward. This condition is called a degenerative spondylolysthesis. If the facets break off, the condition is called isthmic spondylolysthesis. Please see the separate section on this condition elsewhere in this web site. There is also a very informative video about degenerative spondylolysthesis (a common cause of lower back pain).

The facets, when they become degenerative, develop bone spurs. If the bone spurs push medially (inside the spinal canal), then lateral recess stenosis of the spine occurs (crowding of the traversing nerve root). If the spurs form in front, foraminal stenosis results (crowding of the exiting nerve root). If the facet spurs tear the capsule, a ganglion cyst can form which can cause stenosis in either location. Please see these topics covered elsewhere in this web site.

(Click to Enlarge Image) This picture shows the anatomy of a degenerative spondylolysthesis. The arrow in the front of the spine (left side of the picture) points to the step-off or slip of one vertebra on the one below. The arrow in back points to the cause of the slip, the wear of the facet joint allowing the slip.

(Click to Enlarge Image) This is an MRI axial view (bottom up) of disease of the L5-S1 left facet. The arrow points to the damaged facet joint. Note that it is enlarged from bone spurs and the joint surface is irregular (joints should be smooth to glide on each other).

(Click to Enlarge Image) This is a CT of a damaged joint in the lumbar spine. The arrow points to the arthritic and subluxed (misaligned) joint.

Are you suffering from symptoms of lumbar degenerative facet disease?

Would you like to consult with Dr. Corenman about your condition?
You can set up a long distance consultation to discuss your
current X-rays and/or MRIs for a clinical case review.

REQUEST A SECOND OPINION

(Please keep reading below for more information on this condition.)

Lumbar Degenerative Facet Disease Symptoms

Interesting enough, most of the time, lumbar degenerative facet disease is painless and does not cause chronic lower back pain. Many individuals have no significant pain receptors in the facets and it does not register in their brain that their facets have arthritis of the spine. Pain can be generated by nerve compression in the spine and that manifests as buttocks and leg pain. Lateral recess stenosis, lumbar foraminal stenosis, ganglion cysts in the spine, degenerative spondylolysthesis, central stenosis of the spine, and isthmic spondylolysthesis are the typical conditions that occur associated with degenerative facet disease. Instability of the lumbar spine can also occur with lumbar degenerative facet disease. All these conditions are covered in other chapters of this website.

Lumbar Degenerative Facet Disease Treatment

Non-Surgical

Treatment for lumbar degenerative facet disease is based upon the specific facet disease condition that is present (see above). In most cases, if there are no symptoms, there is no need for treatment. If the patient has actual facet pain from arthritis of the spine, physical therapy, chiropractic, medications, activity avoidance and facet injections can be helpful. If facet injections help but last only temporarily, dorsal facet rhizotomies can be effective.

A rhizotomy is an outpatient procedure that attempts to desensitize the facet by burning the small sensory nerves that supply the facet. Its effectiveness in the right setting is about 70% but may have to be repeated in one year as the sensory nerves attempt to grow back.

Surgical

Surgical treatment depends upon the cause of pain. If there is nerve compression and no significant instability, a simple decompression can be helpful. If instability is present, a fusion would be required.

If you are suffering from lower back problems, or have questions regarding lumbar degenerative facet disease, please contact Dr. Donald Corenman, spine specialist and back doctor offering diagnostic and surgical second opinions to patients in the USA and around the world.

Related Content

Donald Corenman, MD, DC

Average rating:

81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel