Zygapophyseal osteoarthritis: Cause of your pain? (What to do?)

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

THEzygapophyseal osteoarthritis, although the name is unusual, is a fairly frequent pathology responsible for back pain. A percentage between 14 to 41% of people suffering from back pain would present lesions characteristic of zygapophyseal osteoarthritis. It is therefore relevant to talk about it and provide the information essential to understanding this condition.

After the definition, this article will make a popular anatomical reminder on the zygapophyseal joints, then will talk about the symptoms, causes and treatment of zygapophyseal osteoarthritis.

Generalities

Definition

Zygapophyseal osteoarthritis is an osteoarthritis which concerns the posterior inter-apophyseal joints of the spine, also called zygapophyseal joints. There exists thezygapophyseal osteoarthritis of the lumbar region (back) but also that of the cervical region (neck).

THEzygapophyseal osteoarthritis differs fromlumbar arthritis or discarthrosis. The first concerns the joints located behind the vertebrae while the second occurs at the expense of the intervertebral discs in front.

The Zygapophyseal Joints: A Simplified Anatomy Lesson

The zygapophyseal joints, also called posterior interapophyseal joints (“facet joints” in English), are the joints that connect the vertebral arches. These are joints of the synovial type, that is to say that joint movements are facilitated by the presence of a viscous liquid called synovia.

These joints have a flat surface. They unite the lower bony processes (left and right) of one vertebra with the upper bony processes (left and right) of the vertebra directly below it.

The articular surfaces of these joints are cartilaginous. As a reminder, articular cartilage is an anatomical structure that lines the bony extremities of joints, allowing them to slide over each other without friction.

Another anatomical structure of zygapophyseal joints is the capsule. The articular capsule which holds them has a variable thickness increasing in the cranio-caudal direction. In other words, the joint capsules of the cervical vertebrae are thinner than those of the thoracic vertebrae, which are less thick than those of the lumbar vertebrae.

The zygapophyseal joints have inclinations that vary according to the types of vertebrae (cervical, thoracic, lumbar). These variable inclinations grant several possibilities of movement to these joints. They allow the movements of rotation, inclination and flexion/extension of the spine.

Note that the spinal nerves emerge through foramina (holes) at this level, and can be compressed or irritated in the event ofzygapophyseal osteoarthritis.

In zygapophyseal osteoarthritis, we observe a destruction of the articular cartilage which thins, cracks and eventually disappears. Once the cartilage is destroyed, all other joint structures can be affected. The vertebral arches, the synovial tissue as well as the joint capsule can be affected. These lesions will then be responsible for pain in the spine.

Symptoms and diagnosis of zygapophyseal osteoarthritis

The injuries

When the articular cartilage is destroyed, there is a joint pinching, that is, a reduction in the space separating the two ends of the bony processes of thezygapophyseal joint. The cracks within the articular cartilage extend to the subchondral vertebral processes (under the cartilage). We note a bone condensation zygapophyses which become dense.

There is also a formation of thick abnormal bone cells at the bone ends called osteophytes or "parrot beaks".

During'zygapophyseal osteoarthritis, we can have a fluid effusion intra articular. This is the synovial fluid produced abnormally in large quantities following an inflammatory reaction of the synovial tissue.

Indeed, the bone cartilage, while deteriorating, releases substances that irritate the synovial membrane. This leads to an inflammatory process. In these circumstances, this synovial fluid produced is also abnormal in quality, and no longer fulfills its main role of protecting the cartilage. It produces the opposite effect by accelerating its destruction even more.

Origin of pain in zygapophyseal osteoarthritis

La pain zygapophyseal osteoarthritis comes from the anatomical structures located around the articular cartilage in destruction since the cartilage itself is not innervated. The pain therefore originates from synovial tissue, subchondral bone, tendons and ligaments which contain nerve endings. Sometimes there may be an abnormal proliferation of nerves inside the damaged cartilage (a phenomenon called neo-neurogenesis).

Characteristics of pain

The pain felt duringzygapophyseal osteoarthritis vary from patient to patient. They are more or less intense, marked by periods of "crises" and periods of calm. This pain is usually triggered after an effort, or after being static for a long time in the same position. It is therefore a mechanical pain. It usually goes away at rest.

In addition, depending on the topography of the osteoarthritis, the pain which is of spinal type radiates towards the upper or lower limbs. One can, for example, witness a symptomatology of lumbago typical accompanied by sciatica or cruralgia if it is a lumbar attack. Sometimes hip pain and knee (knee pain) can be felt.

At the cervical level, pain can touch the neck, and also radiate to the upper limb. The affected person may also notice tingling and numbness hand and fingers.

Besides pain, the other signs are:

• Reflex muscle spasms
• Hypertrophy of the articular masses with the consequences of a limitation of joint movements as well as a joint deformation visible at the level of the back
• Spinal canal stenosis.

Paraclinical diagnosis

The diagnosis ofzygapophyseal osteoarthritis as the diagnosis of most osteoarthritis of other joints can be made with a simple standard x-ray. The cartilage itself is not visible on the radiographs but indirect signs confirm osteoarthritis. It is :

• joint pinching (reduction of the space between the two ends of the zygapophyses)
• subchondral bone condensation (the vertebral arches concerned appear whiter than normal vertebrae)
• the presence of osteophytes (bony prominences) around the zygapophyseal joint.

Causes

The intervertebral discs and l'zygapophyseal joint form a functional whole. Damage to the intervertebral disc changes the geometry of intervertebral movements. This is how an anomaly of the intervertebral disc such as a herniated disc or a disc pinch can affect thezygapophyseal joint. In return, thezygapophyseal osteoarthritis is capable of aggravating disc disease (pathology of the intervertebral disc).

Furthermore, it seems that genetic factors play an important role in the occurrence ofzygapophyseal osteoarthritis. Various other factors are also involved such as:

• age
• the weight
• excessive physical activity

Treatment: What to do?

Treatment approacheszygapophyseal osteoarthritis are similar to all possible treatments of thelumbar arthritis. A specialist can then adapt the treatment according to the needs of each patient among the solutions if after:

– Medicinal means: analgesics (anti-pain), anti-inflammatories

– Non-drug means: exercises, spa treatment, alternative therapies, natural products, anti-inflammatory diet

- The physiotherapy (physiotherapy)

- Theosteopathy

- Last resort : Invasive local interventions: corticosteroid infiltration, viscosupplementation (injection of hyaluronic acid into the joint), equipment, surgery, etc.

Some practical tips

If you have been diagnosed by your doctor with zygapophyseal osteoarthritis the hygieno-dietary measures below must be followed:

• Avoid intense efforts that overload the body so as not to further destroy the bone ends of the joint
• Avoid extreme movements (like hyperflexion or hyperextension of the back) if you are untrained
• Avoid prolonged standing and sitting
• Consult when you feel pain during physical exertion
• Consider weight loss if you are overweight or obese
• See a therapist regularly for better follow-up

In addition to the solutions mentioned above, there are several products and accessories available on the market to relieve pain related to zygapophyseal osteoarthritis. It should be remembered that these tools generally provide temporary relief, and should be used sparingly.

Among the products recommended by our professionals, we have:

• acupressure mat

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• Heated lumbar belt

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• Postural T-Shirts

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• Ergonomic back cushion

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• massage gun

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• Spinal decompression table

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• Foam roller (sport massage roller)

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• Compex

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What about natural remedies?

Although they are not supported by solid scientific evidence, several natural products and home remedies are used to treat various body pains, especially for their anti-inflammatory power.

Here is a non-exhaustive list of plants and essential oils that are effective in controlling pain and inflammation:

• Turmeric : Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.

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• Ginger : In addition to the special flavor it brings to the kitchen and its aphrodisiac properties, ginger is a root well known for its anti-inflammatory powers. THE gingerol gives it its anti-inflammatory action. It is an active component acting on the inflammatory pain related to chronic joint inflammatory diseases, including rheumatoid arthritis, lupus, rheumatic diseases, etc. It has been proven that this active element is also effective in acting on the inflammation linked to arthritis and sciatica. Ginger also has other benefits thanks to its high potassium content and its richness in trace elements (calcium, magnesium, phosphorus, sodium) and vitamins (provitamin and vitamin B9).

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• Omega-3s : Omega-3 are polyunsaturated fatty acids that play a very important role in the functioning of our body. They are provided by food in three natural forms: docosahexaenoic acid (DHA), alpha linolenic acid (ALA) and eicosapentaenoic acid (EPA). Beyond their action on the brain and the cardiovascular system, omega-3s prove very effective against inflammation. Indeed, they have the ability to act on the inflammatory mechanisms in osteoarthritis by slowing down cartilage destruction, thus they reduce the intensity of osteoarthritis pain. Since sciatica is most often linked to inflammation secondary to a herniated disc, it can also respond to omega-3s if you consume them regularly. 

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• Lemon eucalyptus: Eucalyptus is a plant most often used in the form of herbal tea or essential oil. She would have anti-inflammatory effects which give it the ability to act on the bone and joint pain in general and the pain of sciatica in particular.

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• wintergreen : Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the most used essential oils in aromatherapy. This oil extracted from the shrub bearing the same name, is used in massage to relieve sciatica and act like a analgesic. Indeed, it provides a heating effect thanks to its ability toactivate blood circulation locally.

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Conclusion

Many patients with back pain suffer from zygapophyseal osteoarthritis. It is a pathology of the posterior interapophyseal joints of the spine not to be confused with lumbar osteoarthritis.

The main symptom is pain mechanical type disappearing at rest. The plain x-ray makes it possible to make the diagnosis through three capital indirect signs: joint narrowing, subchondral bone condensation, osteophytes.

There is a correlation between the disc disease and l'zygapophyseal osteoarthritis but genetics, age, weight and intense sport are also risk factors.

Treatment ofzygapophyseal osteoarthritis is no different than thelumbar arthritis in terms of medication and physical means. However, there are lifestyle rules to observe as soon as the pathology is diagnosed. Follow-up by a health professional is important.

Good recovery !