When Should I Consider Surgery For Facet Joint Pain

Our spine and pain management experts at Neurosurgery One only recommend surgery for facet joint pain for patients experiencing severe pain that cannot be relieved by nonsurgical options. For cases involving nerve root compression from enlarged facet joints, degenerative disc disease, or spinal instability, surgery is not typically a recommended option unless its a last resort.

When surgery is necessary, spine fusion surgery may be recommended. Spine fusion surgery limits the motion at a painful vertebral segment. This helps to reduce pain from the joint.

Rheumatoid Arthritis Of The Spine

Rheumatoid arthritis is an autoimmune disorder, meaning that the immune system turns on itself. It attacks synovium the lining of the joints. Although rheumatoid arthritis is more common in other joints, it can also affect the spine, specifically the cervical region . Rheumatoid arthritis of the spine is not caused by wear and tear, so its considered an inflammatory arthritis. It may cause back pain even when these joints are not in use. It tends to affect women more than men.

How Is Lumbar Facet Joint Pain Diagnosed

A diagnosis of lumbar facet joint pain is primarily based on a patients symptoms and physical examination findings. Typical symptoms and signs of lumbar facet joint pain include low back pain. Patients commonly report that the pain is worsened with prolonged standing or walking. While imaging such as x-ray, magnetic resonance imaging , or computed tomography may be useful to evaluate for other potential sources of low back pain, rule out more serious issues such as fractures, tumors, or infections, and help plan procedural approach, there is actually very limited data to suggest that imaging plays a role in being able to more conclusively rule in or rule out the facet joints as a source of pain. Consequently, the gold standard method for diagnosis of lumbar facet joint pain is patient response to diagnostic medial branch nerve blocks.

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How Is Spinal Arthritis Treated

The treatment for spinal arthritis depends on many factors. They may include your age, level of pain, type and severity of arthritis and personal health goals. Because the joint damage caused by arthritis is irreversible, the treatment usually focuses on managing pain and preventing further damage.

Nonsurgical treatments for spinal arthritis may include:

• Nonsteroidal anti-inflammatory drugs and corticosteroids to reduce pain and swelling

• Other medications targeting specific symptoms or triggers of inflammatory arthritis

• Physical therapy to improve back muscle strength and range of motion in the spine

• Lifestyle changes to reduce inflammation or stress on your spine: losing weight, quitting smoking, changing your posture, etc.

Exercises For Facet Joint Pain Relief In Low Back:

Please try the following at your own discretion. If you feel more pain from these exercises, then you should seek medical help.

In many cases, lower back pain caused by facet joints can mimic other conditions such as herniated discs and compressed nerve roots. If conservative treatment methods fail to reduce symptoms, consider consulting with a physiotherapist or chiropractor to determine if something else is causing your symptoms.

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Reliability Of Ct Readings

All readers were trained by an experienced research musculoskeletal radiologist . A reading protocol for evaluation of FJ OA based on the above outlined grading scheme was developed. Using this protocol, the intra- and inter-rater reliability was calculated for two readers. All CT scans were then analyzed in blinded fashion. To evaluate for reader-drift, intra-rater reliability was periodically reassessed by inserting one repeated reliability scan for every 10 new scans. Before analyzing each new set of CT scans, 5 previously analyzed CTs were reevaluated to recalibrate the readings to a standard. The intra-observer reliability for grading different FJ OA indices varied between 0.64 and 0.91. The inter-observer reliability ranged from 0.59 to 0.94. This range of kappa statistics represents fair to excellent reproducibility.

What Treatments Are Available

While facet joint arthritis canât be reversed, there is evidence that exercise, lifestyle changes and careful management of your back pain can contribute to better quality of life. If conservative therapies fail to help you manage and control the pain, your doctor may recommend injections, ablations or surgery.

Self care: Using correct posture and keeping your spine in alignment are important things you can do to prevent painful episodes. You may need to make adjustments to your daily standing, sitting, and sleeping habits. Losing weight can reduce the load on the facet joints and alleviate pain.

Physical therapy. Exercise is very helpful for a painful facet joint, and it can help you heal faster. Physical therapists can instruct you on proper lifting and walking techniques, and theyâll work with you to strengthen and stretch your lower back, leg, and stomach muscles . Although a physical therapist may show you strengthening and stretching exercises, itâs your responsibility to follow them.

Medications: Some patients may require oral anti-inflammatory medications or topical patches, creams, salves or mechanical bracing. Sometimes muscle relaxers are prescribed for muscle spasms.

Surgery: If all other treatments do not provide pain relief, spine fusion surgery may be an option. This usually occurs when there is nerve root compression from enlarged facet joints, degenerative disc disease, or spinal instability.

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Whats The Next Step If Facet Joint Injections Do Not Work

If your injection does not offer pain relief, it may be because the injection did not reach the source of pain or because your pain is not caused by your facet joints.

Your doctor can recommend what to do next. They may suggest trying a different injection or an alternative treatment like radiofrequency neurotomy, where heat is used to destroy the nerves that are causing pain.

Surgery For Spinal Arthritis

Surgery may be recommended for spinal arthritis if other treatments dont sufficiently relieve pain. The goals of the surgery may include:

• Stabilizing the spine by fusing several segments together in a procedure called spinal fusion

These surgeries can be performed as open procedures or with a minimally invasive approach. There are pros and cons to each method. The surgeon will review and discuss the options before the operation.

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Take Away Points About Facet Joint Syndrome

Facet joint syndrome can cause chronic pain in any region of your spinefrom your neck to your low back. Fortunately, diagnostic injections can pinpoint the site of your pain, and your doctor has several nonsurgical and minimally invasive therapies to help manage your pain and restore healthy range of motion.

More on this topic

Are There Any Alternative Lumbar Facet Joint Injection Options That Are Typically Covered By Insurance Companies

As an alternative to PRP injections, lumbar facet joint injections with corticosteroid can be performed to help alleviate low back pain. Using x-ray guidance, needles are carefully and precisely guided to the painful facet joints. Once the facet joints have been accessed, a steroid solution is instilled through the needle and into the joints. This helps to decrease inflammation and, subsequently, decreases pain and improves function.

At a Glance

• Harvard Fellowship-Trained Interventional Spine & Sports Medicine Specialist
• Double Board-Certified in Physical Medicnie & Rehabilitation and Pain Medicine
• Assistant Professor of Physical Medicine & Rehabilitation and Orthopedic Surgery

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Epidural Steroid Facet Injections

Physicians can use epidural injections to both diagnose facet joint syndrome and ease pain caused by the condition. This injection method uses either steroids or a combination of steroids and anesthetics.

When either of these injection types is used to diagnose facet joint syndrome and locate pain points, the diagnostic injection includes an anesthetic. The anesthetic helps locate the affected facet joints or medial branch nerves.

Synovial membrane tissue makes up joint capsules that surround facet joints. Each joint capsules upper pad is fused with the spinal nerves fatty sheath, and the capsule contains nerves that send signals to the brain. When a joint capsules synovial membrane is inflamed, facet joint injections can reduce pain in the following ways:

• Reducing pain receptor sensitivity to decrease pain signals to the brain
• Hindering inflammatory chemical production

If several facet joints are producing pain, your physician may deliver more than one injection to target each affected facet joint. The success rate of facet joint arthritis treatment injections can vary from person to person. Some patients experience short-term pain relief, while others experience long-term pain relief or find that their pain completely dissipates.

What Are Natural Remedies For Facet Joint Pain

Rest may be one of the best ways to alleviate your facet join pain. Slow walking can also be a natural remedy for facet joint pain. Some patients have found relief with acupuncture and physical therapy. Certain exercises may also provide relief. But its important to consult your physician before engaging in any exercises, as certain movements could make your pain worse.

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Facet Joint Sprain A Pain In The Back

Back injuries are super common in the population, at least 80% of people will have an episode of back pain in their lifetime. Most people have heard of or know of someone who has damaged their disc, but a more commonly seen injury is that of the facet joint sprain.

The facets are not in the central section of our vertebrae but extend laterally, and they are connected to the vertebra above/below them via ligaments. These facets joints are located through all of your neck, middle and lower back.

How To Do It:

Begin by positioning yourself on the floor on your hands and knees with your knees slightly wider than your hips. Turn your toes inwards to touch and push your hips backwards while bending your knees. Once youre in a comfortable position, straighten your arms forward and allow your head to fall forwards into a relaxed position. Hold this position for 20 to 30 seconds. Slowly return to the starting position. Aim for 3 repetitions.

It helps to strengthen the muscles of the lower back and abdomen.

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What Aggravates Facet Joint Pain

Facet pain is usually heightened with activities that cause excess movement of the spine such as rotating or bending the spine backward, twisting, and lifting. Conversely, bending forward may relieve the pain.

Facet pain also tends to be higher in the morning after a nights sleep, following heavy exercise, or after sitting still for long periods of time like in an office chair or driving a car.

Facet Joint Syndrome Diagnosis

The pain that comes with facet joint syndrome can mimic other spine conditions, so a physician will carefully evaluate your condition to determine the source of your pain and make a diagnosis. To accurately diagnose facet joint syndrome, your doctor will consider the following factors:

• Your medical history
• Any problems sleeping or standing

If your doctor suspects you may have facet joint syndrome, they may ask you to move or stand in various positions and indicate where you feel pain. They may also feel for tender spots on your spine and work your joints to determine where the damaged facet joints may be located.

Once your doctor has a general idea of where your pain is coming from, they may order imaging studies to support their diagnosis and rule out any other spine-related conditions. An MRI, CT scan or X-ray provides a clear image of the spine so your physician can locate the damaged facet joints.

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Facet Joint Syndrome: Common In Low Back But Possible In Neck And Midback

Low back pain is among the most common medical complaints worldwideand facet joint syndrome is a common cause of low back pain. The most common site of facet joint pain in the lumbar spine is at the L4-L5 level followed by L5-S1. Some researchers estimate that facet joint syndrome accounts anywhere from 15% of all low back pain complaints to 59.6% in men and 66.7% in women.¹

While facet joint syndrome most often affects the lumbar spine, the cervical and thoracic spinal regions may be affected as well. After the low back, the neck is the second most common location of facet joint syndrome, with a prevalence ranging from 30% to 70% of neck pain cases. Due to the articulations of the ribs with the vertebral body, motion is very limited. In the neck, facet joint syndrome most often occurs at the C4-C5 level.¹

The thoracic spine, or midback, is the least likely region of the spine to be affected by facet joint syndrome. The prevalence of facet pain ranges between 33% and 48% of midback pain cases.¹

How Painful Is A Facet Joint Injection

During the injection of local anesthesia, you may feel a pinch and some slight burning as it takes effect. However, it should not cause intense pain.

The facet joint injection itself should not cause any pain since the area will be numbed. Youll likely feel some pressure around the injection site.

Once the pain reliever wears off, you may have soreness around the injection site for a few days. Your doctor may prescribe a pain reliever if you have significant pain.

, researchers reported 101 complications across 11,980 procedures. Eight of these were considered major. All major complications were related to infection, and one person died of an infection.

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Data Collection And Outcome Evaluations

All the cases were divided into a LBP group and a non-LBP group in this study. We compared their clinical parameters , and facet joint parameters . Facet joint parameters were measured on the axial CT images at L3-L4, L4-L5, and L5-S1, using bone windows by using the method described by Noren et al and Li et al .

Fig. 1

Diagram of the method used to measure the facet joint angle. The facet line is drawn between the 2 peaks of each of the superior articular facets . The midline is drawn through the center of the lumbar vertebral body and the middle point of the base of the spinous process. The angle between the midsagittal line and facet line was measured for each side of the lumbar vertebral body . Facet orientation = /2 Facet tropism = |R-L|

Treatment Options For Facet Joint Disorders

Nonsurgical treatments are usually the first line of treatment and have a favorable success rate in terms of reducing pain that originates from a facet joint. A full range of treatments are available, and typically several are done at the same time.

A facet joint injection may be done to help diagnose the facet joints as the source of pain, as well as to provide pain relief. Watch:Facet Joint Injections Procedure Video

For pain and dysfunction that does not respond to nonsurgical care, or for severe conditions, such as complex fractures, significant dislocations, or spinal cord involvement, surgical intervention may be recommended.

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Can Facet Injections Make Your Pain Worse

A facet injection can lead to increased pain. This pain is usually temporary and related to swelling at the injection site.

It usually goes away once the medication has a chance to take effect. If the area around your injection is sore, you can try putting an ice pack on it for up to 20 minutes at a time.

Facet joint injections generally cost more than $1,000 in the United States. One surgery center in Texas lists their price as $1,276 to $1,458. The exact cost depends on factors such as:

• the extent of your procedure
• your geographic location
• the clinic or hospital you visit

In a , researchers estimated that the direct cost of a similar procedure, a facet joint nerve block, was $758.08. However, this does not cover the cost of drugs and medical therapy. The estimated total cost was 67 percent higher.

What Is Facet Joint Syndrome And How Can It Be Treated

Symptoms

The facet joints are the connections between the vertebrae of the spine that allow for the flexion and extension of the spine. Like any other joint in the body, the facet joints can become inflamed and irritated due to repetitive stress or trauma. The pain and stiffness associated with this inflammation is often referred to as Facet Joint Syndrome and can manifest as episodes of severe pain that can occur from a few times a month to everyday.

Patients will generally experience tenderness over the facet joint as well as a loss of spinal flexibility. If the facet joints in the lumbar spine are affected and compress a nerve root, the pain will often radiate from the lower back into the buttocks and the back of the thighs. Cervical facet joint pain, on the other hand, radiates into the shoulders or upper back and can even spread upward to the neck causing headaches.

Treatment

Early treatment of facet joint pain offers the best prognosis as the more the joints swell the more likely they are to cause irritation to the spinal nerves. Treatment for facet joint pain focuses on reducing pain while restoring range of motion in the spine. Nonsurgical options include physical therapy, which is used to strengthen the muscles surrounding the facet joints.

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Pain That Originates Within The Facet Joint

Degenerative or traumatic conditions affecting the facet joints surface and/or the nearby discs may cause4:

• Spinal osteoarthritis: Natural wear-and-tear of the facets cartilage due to aging may result in inflammation and stiffness due to bone-on-bone grinding within the joint during movement.
• Overexertion of the facets. Movement of the spine beyond its normal limit can cause the facet joints surfaces to be forced out of place.

Pain may also result from the entrapment of soft tissue between the facets.