A Common Cause of Neck and Back Pain
If you experience chronic pain and or severe spasms any where in your neck or back and it worsens when standing or leaning backwards after being bent over, then you might be suffering from facet joint syndrome or chronic axial back pain.
Facet Joint Syndrome
Facet syndrome is a common form of arthritis and when seen in adults over 50 years of age it is usually caused by normal wear and tear of the spine. This condition also may affect younger patients and is usually related to an injury or overuse. There are millions of Americans that suffer daily from this condition but they find ways to cope and adjust their lifestyle in fear of surgery. At Jasper Spine Institute we take a complete history of your symptoms and use diagnostic imaging and injections to pinpoint the facet joint as the pain generator. If the facet is determined to be the cause our interventional pain physician can relieve your pain without surgery and return you to work and a healthy and active lifestyle.
Causes of Facet Joint Syndrome
Facet syndrome can occur anywhere in the spine. It develops in the small joints located between each vertebra called facet joints. These joints are in constant motion, providing the spine with both the stability and flexibility needed to walk, run, bend, sit, and twist. The joint surfaces are lined with cartilage allowing them to glide easily over each other. As we age, the cartilage gradually wears away, and in many cases, growths called “bone spurs” can develop. Friction between the bones leads to the tenderness, swelling, stiffness, and pain of arthritis. Though generally the result of the natural aging process, the initial cause of arthritis, or facet syndrome, may be an injury or overuse in youth.
When a joint is damaged through normal deterioration, injury, or repetitive trauma, it may become swollen, painful, and stiff. Inflammation is usually temporary, but in arthritic joints, it may cause long-lasting or permanent disability. In addition to age, other risk factors for facet syndrome include:
- Excessive weight
- Overuse due to sports or heavy labor
- Presence of disease such as gout, other types of arthritis, or infections
- Damage may stem from injuries or trauma, including whiplash, Excessive lifting of heavy weight
- Pain that is often worse in the beginning and end of the day or with a change in weather
- Lower back pain that radiates into the buttocks, pelvic area, or thighs
- Neck pain that radiates into the shoulders, arms, or hands
- Headaches at the base of the skull, aching behind the eyes, and/or ringing in the ears
- Weakness or numbness in your legs or arms
- Pain from Standing long period of time in low back
- Riding or sitting in the car for a long period of time can flare up facet
A number of non-surgical and conservative treatment options can be done to improve chronic facet syndrome or axial back pain. Many of these treatments can bring temporary relief and in some patients significant relief.
- Physical therapy aimed at strengthening your core muscles and back to improve your posture.
- Heat and cold therapy
- Non-steroidal anti-inflammatories, called NSAIDs (e.g. ibuprofen) and the more recent COX-2 inhibitors (e.g. Celebrex)
- Modifying daily activities to reduce stress on the back muscles
When conservative care is not enough and the symptoms become chronic and exist for more than 6 months, then interventional injections and procedures may help. The facet joints are innervated by a small medial branch nerve that extends from the exiting nerve to the facet joints an into your muscle column in your back. This nerve transmits the sensation of pain from your back to your brain. In patients suffering from facet mediated back pain a pain management physician will diagnose the patient with this condition through a physical examination, radiographic studies and a confirmatory facet medial branch block injection. If the patient has a greater than 90% pain relief, they typically are a good candidate for a traditional percutaneous radio frequency rhizotomy.
During a percutaneous rhizotomy, a probe is inserted through the skin under X-ray guided image allowing for indirect visualization to target the medical branch nerve. The patient can elect to have sedation or not any depending on their tolerance for procedures. The probe is then heated thus attempting to ablate the small nerve and relieve pain. The results for a percutaneous rhizotomy are: 70% of patients get relief from their back pain for about 1 year and in some patients up to 5 years.
When percutaneous radio frequency does not work or last long enough, The Jasper Spine Institute has begun performing a new and innovative endoscopically assisted radio frequency rhizotomy where with or without sedation, a 7mm tube is inserted under X-ray image to the facet and a working channel endoscope with HD camera is inserted into the tube and under direct visualization the physician ablates the medial branch nerve with a radio frequency probe. The results in clinical literature have suggested about 80% of patients have experienced 50% or more reductions in the back pain relief for up to 5 years. Furthermore, the endoscopic approach affords clinically superior longevity when compared to published results of radio frequency ablation.
The Jasper Spine Institute Interventional Pain Management Advantage:
- Less than ¼ inch incision
- Less post-operative pain and recovery than traditional minimally invasive procedures
- Outpatient procedure with patients discharged within 2 hours of surgery
- Return to work within 3-5 days*
At Jasper Spine Institute we listen and work with you to develop a unique treatment regime that addresses your pain and symptoms. Our goal is always to provide solutions whether conservative or surgical so that you are able to return to the quality of life you want without the pain and suffering.
* Always seek your physician’s opinion when it is safe to return to work. Also, light administrative duty is recommended until your physician approves of any physical demands at your place of work.
Five Year Long-Term Results of Endoscopic Dorsal Ramus Rhizotomy and Anatomic Variations of the Painful Lumbar Facet Joint; Farhan Siddiqi, MD, Presented at 2013 SMISS Annual Conference