Cervical facet osteoarthritis: Definition and management

acervvv Cervical facet osteoarthritis

If your doctor ever diagnosed you withfacet osteoarthritis cervical, we invite you to read this article which deals with all aspects of the disease, namely its etiologies, its diagnosis (clinical and paraclinical), its symptoms as well as the various therapeutic options that will allow you to relieve yourself.

Definition and anatomy

Le cervical spine is the bony part of the neck, it is a set of seven vertebrae named from C1 to C7 and linked together by intervertebral discs, ligaments and articular surfaces.

The vertebrae are made up of a vertebral body and facet joints located at the back. These facets are four in number for each vertebrate two of which make it possible to articulate with the upper vertebra and two others with the lower vertebra.

These joints are lined with sufficiently smooth and lubricated cartilage to allow the vertebrae to slide freely during movement.

Although very stable, the cervical spine and a highly flexible region allowing multi-directional movements. It is therefore subject to frequent friction, particularly at the level of the joints, causing Osteoarthritis et degeneration.

THEcervical facet osteoarthritis is often observed at the level of the articular facets connecting the vertebrae going from C4 to C7.

What causes cervical facet osteoarthritis?

The origin and precise etiologies of cervical facet osteoarthritis do not yet seem to be fully known. There is, however, one certainty regarding the cause which is that it is related to the wear and tear of the cartilage lining the joints.

Indeed, the neck being a very mobile and highly stressed region, the cartilage tends to wear out with age, which leads to a Osteoarthritis.

THEage is also the provider of multiple changes in the cervical region, such as dehydration and shrinkage of the intervertebral discs or thickening of the bones and ligaments which can increase the risk of friction at the level of the facet joints and therefore that of osteoarthritis.

It is also important to note that other factors can cause cervical facet osteoarthritis, including:

  • male sex,
  • A history of trauma to the neck region (rabbit neck),
  • The significant frequency of microtraumas to the neck,
  • The exercise of certain professions soliciting the cervical region,
  • A malformation of the cervical spine
  • Etc

How does it manifest?

It happens quite often that a cervical facet osteoarthritis is asymptomatic and can only be seen on imaging tests, especially when there is no inflammation. This is due to its installation progressive which gives the body time to adapt to it as it goes.

When cervical facet osteoarthritis is symptomatic, it may be responsible for certain symptoms which may be, among others:

  • A pain at the level of the neck which may radiate to the arms, shoulders, back (scapula), or chest;
  • A neck stiffness;
  • Personalized paresthesias and numbness at the level of the upper limb (arms, forearms and main);
  • Personalized headache or headache;
  • Un creak at the level of the neck during its mobilization;
  • A vertebro-basilar insufficiency, due to the formation ofosteophytes at the level of the vertebrae which cause irritation of thevertebral artery.

This situation is fortunately rare and can cause: migraines, dizziness, tinnitus, visual disturbances, nausea and vomiting, fatigue and ringing in the ears.

It also sometimes happens that cervical facet osteoarthritis is at the origin of a symptomatology linked to the suffering of the spinal cord, such than muscle weakness, a abolition or exaggeration of reflexes to coordination disorders. This is the case when complications such as myelopathy or radiculopathy cervical occur.

What about the diagnosis?

The diagnosis of cervical facet osteoarthritis is generally primarily clinical, it is based on:

Questioning

The doctor will study the symptoms presented by the patient: their duration, their mode of onset and their evolution. The patient should also be questioned about any previous illnesses or traumas, particularly in the cervical region, as well as about their occupation and habits.

A clinical examination

Thorough and complete, the clinical examination, which must include a neurological examination with assessment of muscle strength, osteo-tendinous reflexes and gait. As well as an examination of the mobility of the neck.

X-ray examinations 

The doctor usually begins by ordering a standard x-ray of the cervical spine, this makes it possible to highlight indirect signs of osteoarthritis such as articular narrowing, bone condensation or the presence of osteophytes at the level of the facet joint.

A computed tomography or CT scan may also be requested in order to confirm the diagnosis and rule out others.

Finally, when there are significant neurological signs, a IRM (magnetic resonance imaging) can be performed to assess the impact of cervical facet osteoarthritis on the spinal cord.

Treatment of cervical facet osteoarthritis

The management of cervical facet osteoarthritis has multiple aspects and depends on several factors such as the type of symptoms, the degree of damage and the impact of this pathology on the functional level.

Response to treatment varies from person to person, and each patient responds differently to each treatment method.

Among the methods of support, we can cite:

Non-drug treatment

One of the basics of management of osteoarthritis in general is the recommendation of rest, which is more so when it comes to cervical facet osteoarthritis, because the cervical region is often solicited, which makes the very painful seizures.

It is nevertheless important to specify that the rest should only be of short duration because in the long term it is possible that it has the opposite effect.

In order to prevent the onset of painful attacks, the healthcare professional may sometimes advise the use of a neck brace (cervical collar). However, it is useful to specify that its use must be limited to certain exceptional situations (such as an attack of pain, a long trip or a demanding job). Indeed, it can also cause muscle atrophy and neck stiffness that can cause the situation to worsen.

La physiotherapy and l'osteopathy also represent therapeutic options of choice in the management of cervical facet osteoarthritis, although they have no direct effect on the phenomenon of osteoarthritis. Nevertheless, they make it possible to reduce tension in the neck which can cause or be the consequence of significant pain.

Drug treatment 

One of the consequences of cervical facet arthrosis is the appearance of a significant inflammatory process in the joints. His medical care therefore consists of takinganti-inflammatory in order to reduce the latter and thus reduce the pain.

It is also possible to use thecortisone infiltration at the level of the joint when the drugs no longer bring the expected effect.

Surgical treatment

Recourse to surgery in the management of cervical facet osteoarthritis is generally rare. However, certain serious conditions such as myelopathy or radiculopathy with spinal compression may require surgery to free the affected nerve roots.

On a technical level, the surgery can consist of lifting the pressure in order to release the bone marrow, in the event that the latter is completely or partially compressed, or of defusing the vertebrae and removing the bone spurs.

Among the surgical gestures used we can cite: laminectomy, discectomy, arthrodesis, corpectomy, etc.

The choice of these surgical approaches must always be made according to the therapeutic indications, such as the age of the patient, the evolutionary stage of the disease, the degree of risk of the intervention, the decision of each surgical team, etc.

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