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Back Problems Message Board

Back Problems Board Index

The facet joints are the synovial joints located at each vertebral segment that, along with the intervertebral discs, allow the spine to bend and twist. As a fluid-filled joint like the knee or ankle, they tend to enlarge as the work to stabilize the spine as the discs begin to degenerate. Unfortunately, the aging process in the human spine begins in our twenties. Just every day wear and tear and forces of gravity pushing down on the discs is enough to begin this process.

You will notice the report indicates facet arthritis. This is what I am referring to. The joints tend to enlarge and sometimes little bone spurs develop along with these changes. This often results in a narrowing of the neural foramina, which are the openings through which a spinal nerve exits the spine and goes out to the part of the body it innervates.

This process is the most advanced at the lowest lumbar segment, L5-S1. At this level, there are several things going on that indicate the degenerative process. In addition to facet joint arthritis, the disc is drying out and in addition, the disc is protruding out of the disc space. Disc material is pushing into the foramen at this level...and, (due to limited space) this is pushing over into the thecal sac (the tough ligamental sac that encompasses the spinal fluid and the bundled nerves of the cauda equina). It appears that this is encompassing the spinal nerve root at this level. This is what is causing the radiculopathy in your leg.

It may be that with some physical therapy the disc protrusion will heal and move off the nerve root, which should alleviate the pain. A series of epidural injections may aid in this process. If conservative treatments are tried and fail, then a surgery to remove disc material from indenting the thecal sac may be recommended.

I don't know about the cause of the swelling.

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