Osteoarthritis Of The Thoracic Facet Joints

From the round, almost donut-shaped, vertebral body project two bony processes, called articular processes. The articular processes of one vertebra rest against the articular processes of the vertebrae above and below, forming joints that are called facet joints.

The facet joints provide stability in the spine, while still allowing for rotational movements. These joints are covered in cartilage, which provides cushioning, and are also covered by a synovial membrane, which provides lubrication for the joint.

Osteoarthritis of the facet joints involves the breakdown of cartilage between these joints, resulting in pain and reduced range of motion.

Various factors can contribute to the development of facet joint osteoarthritis, including the wear and tear of day-to-day movements, prior injuries to the facet joints, inflammatory processes, and even genetic factors.

Once the protective layer of cartilage becomes damaged or worn away, movement within the spine causes friction, or rubbing, between the vertebrae, which results in inflammation.

Ongoing inflammation in the area of the facet joints can then cause the synovial membrane, which provides lubrication to the joint, to become thickened; when the membrane is thickened, it is less able to lubricate the facet joints, resulting in more friction, and therefore more inflammation, in the joint.

These degenerative changes to the cartilage and synovial membrane surrounding a facet joint can also result in damage to the bone itself.

As the vertebrae move against each other, no longer protected by the smooth and lubricated barrier of cartilage and synovial membrane, the resulting friction can result in the development of excess bone growth, called bone spurs.

Bone spurs then result in increased friction in the facet joints. The degenerative changes then become cyclic: damage to the cartilage, synovial membrane, and the bone itself results in increased friction and inflammation, which then results in increased damage to the tissues.

Initial degenerative changes to the cartilage are generally asymptomatic, as cartilage does not contain any nerves. As the degeneration progresses, however, symptoms will begin to appear, and can range from mild to severe; some of these symptoms include:

• Pain with movements of the thoracic spine, including bending, twisting, or weight-bearing
• Spasms of the muscles surrounding the thoracic spine, resulting in muscle stiffness and decreased range of motion
• Symptoms of nerve irritation or impingement (called radicular symptoms), range from numbness and tingling to sharp, shooting, or burning pains

What are the symptoms of severe osteoarthritis of the thoracic spine?

As degenerative changes in the thoracic spine progress, more serious complications can develop. Bony spurs that develop on the vertebrae can begin to intrude into the small openings where nerves run or into the spinal canal, where the spinal cord runs, resulting in irritation or compression of the nerves or the spinal cord.

Likewise, damage to the synovial membrane can result in the development of synovial cysts, which are sacs of fluid that can protrude into the spinal canal or into the openings for nerves, compressing either nerves exiting the spinal cord or the spinal cord itself. Symptoms of these issues include:

• Debilitating pain in the mid back, affecting activities of daily activity (including sleep)
• Associated weakness

Severe osteoarthritic changes in the thoracic spine are relatively rare compared to degenerative changes in the cervical (neck) and lumbar (lower back) spine.

Statistically, a systematic review of the data available for thoracic spine pain (TSP) published in the BMC Musculoskeletal Disorders Journal noted that it is difficult to comment on the prevalence of thoracic spine pain because “specific results for the thoracic spine are rarely reported”.

Rather, only low back or just “back” pain is reported which may encompass more than one spinal area. “However, the authors of the article concluded that the data that is available supports the premise that TSP is particularly prevalent among youth and adolescents, noting that up to 10% of adolescents experienced TSP that interfered with school or leisure and TSP prevalence seemed to be highest during backpack use.”

The study further noted that factors including poor posture, inappropriate backpack size and/or weight, chair height, participation in certain sports, and trouble with homework were correlated with the incidence of TSP.

It is also noted that further study specific to TSP is required to glean more accurate data. Because of the increasing rates of TSP in youth and adolescents, the authors further speculate that more severe degenerative thoracic spine conditions may be seen in the future (Briggs et al. 2009).

Some common risk factors include:

• Poor posture (which can be associated with multiple factors, including frequent backpack use, tight or weak muscles, and spinal changes due to trauma or factors like osteoporosis)
• Age
• Increased weight or obesity
• Inflammatory conditions, such as gout, diabetes, and other types of arthritis (including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and reactive arthritis), or even digestive conditions like IBS

Diagnosis of osteoarthritis of the thoracic facet joints will involve a medical appointment to get an accurate medical history and perform a physical examination.

Further diagnostic testing, such as bloodwork to rule out other causes of spinal pain like rheumatoid arthritis, X-rays to visualize the arthritic joints, and other diagnostic imaging, such as an MRI, to assess for nerve involvement, may be requested.

Another method of assessing the cause of your pain may be a diagnostic injection, in which a numbing agent is injected to determine if it temporarily resolves your pain.

After a diagnosis of thoracic facet joint osteoarthritis, the approach to your treatment will initially depend on numerous factors, including your age, the severity of your pain and limitations, and other health factors.

Arthritic changes are, unfortunately, irreversible; however, treatments are available to slow or even prevent further degenerative changes.

Some options for managing this condition include:

• Acetaminophen to reduce pain
• NSAIDs (non-steroidal anti-inflammatory drugs) to reduce pain and inflammation
• Other oral medications specific to treating arthritis and inflammation
• Physiotherapy
• Aquatics or pool therapy program
• Acupuncture and Acupressure
• Massage therapy
• Occupational therapy (including improving the ergonomics of your workstation, if applicable)
• Exercise to improve posture and reduce weight
• Dietary changes to improve weight and reduce inflammation
• Smoking cessation
• Postural braces

At the Wilderman Medical Clinic, we offer a variety of interventional and non-interventional pain management options, including:

Interventional pain management for osteoarthritis of the thoracic facet joints:

• Dextrose (prolotherapy) injections for thoracic facet joint osteoarthritis
• PRP (plasma-rich protein) injections for thoracic facet joint osteoarthritis
• nStride injections for thoracic facet joint osteoarthritis
• Trigger point injections
• Facet joint injections to the thoracic facet joints
• Medial branch block injections for thoracic facet joint osteoarthritis

Non-interventional pain management for osteoarthritis of the thoracic facet joints:

• Psychotherapy
• Kinesiology education sessions

Radiofrequency Ablation (RFA) is another treatment available for chronic nerve pain related to thoracic facet joint osteoarthritis. When other treatments have failed to provide sufficient relief from pain, RFA may be recommended as an alternative.

This procedure uses the application of heat at very specific sites in order to destroy a portion of nerve tissue responsible for transmitting pain signals to the brain.

This treatment can result in long-lasting improvement in pain levels and quality of life.

Surgical intervention of osteoarthritis of the thoracic spine is viewed as a last resort. The only surgical option for treatment is a fusion of the vertebrae to prevent the pain associated with movement in the spine.

Since OA of the spine typically involves multiple vertebrae, surgical intervention would likely require the fusion of multiple vertebrae as well, which would cause significant limitations in mobility.

Briggs AM, Smith AJ, Straker LM, Bragge P. Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC MusculoskeletDisord. 2009 Jun 29;10:77. doi: 10.1186/1471-2474-10-77. PMID: 19563667; PMCID: PMC2720379.

De Witt, David. What is spinal osteoarthritis (facet joint arthritis)? September 23, 2020. Retrieved from https://www.arthritis-health.com/types/osteoarthritis/what-spinal-osteoarthritis-facet-joint-arthritis

Spinal arthritis (arthritis in the back or neck). Johns Hopkins Medicine. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/spinal-arthritis

Ullrich, Peter. Facet Joint Osteoarthritis. March 15, 2001. Retrieved from https://www.spine-health.com/conditions/arthritis/facet-joint-osteoarthritis