Facet Syndrome and Arthritis
Facet Syndrome, one of the most common causes of back pain, is a condition affecting the joint facets of the superior articular process of one vertebra and the inferior articular process of the vertebra above it. Each vertebra has two facet joints, one with the corresponding vertebra above it, and one with the corresponding vertebra below it.
In Facet Syndrome the cartilage on these joint surfaces has deteriorated to the point where friction between the joints causes swelling, tenderness and pain. Often nerve impingement also occurs. Facet syndrome can occur anywhere throughout the spine but occurs most often (approximately 55% of cases) in the cervical (neck) vertebrae, and 31% of cases occur in the lumbar (lower back) vertebrae.
Facet syndrome typically develops into spinal osteoarthritis (spondylosis). Facet syndrome is most often age related but can occur due to injury.
Who is at risk of developing facet Syndrome?
- Being overweight increases your risk of developing facet Syndrome.
- Excessive use due to sports or other active lifestyles.
- Injuries from whiplash or even odd sleeping positions can injure your spine.
- Sudden jerking motion of the neck, improper lifting, or any other trauma to the spine can increase the risk of developing Facet Syndrome.
- Persons with a family history of facet syndrome are at higher risk.
- Extended periods of heavy labor (construction work).
- Disease: gout, arthritis, and infections increase the risk of developing Facet Syndrome.
What are the symptoms of facet syndrome?
- Prolonged standing often increases pain levels.
- Pain that is more severe in the mornings and evenings, or with changes in weather such as cold and rainy weather.
- Neck pain radiating into the shoulders, arms, or head.
- Sitting for long periods and driving/riding in automobiles for long periods often increase pain levels.
- Headaches, usually occurring at the base of the skull, ringing in the ears (tinnitus), and aching behind the eyes.
- Scoliosis (abnormal curvature in the spine).
- Weakness or numbness in your legs or arms, shooting pains, tingling sensations, dull achiness.
- The feeling of your bones grinding together when you move, often it seems as if you can actually hear this.
- Lower back pain that often radiates into the buttocks, pelvic region, and/or thighs.
How is Facet Syndrome diagnosed?
Your medical history, family history can play a role, injuries, or even age can lead to the development of facet Syndrome. Your Chicago pain doctor will discuss your symptoms with you and if facet syndrome is suspected you may undergo x-rays, MRI (magnetic resonance imaging), or a CT (computed tomography) scan may be used to get a clear picture of what is occurring (Effect of facet joint injection versus systemic steroids in low back pain: a randomized controlled trial 2014).
How do you treat Facet Syndrome?
Treatment for Facet Syndrome depends on the severity of the condition. Less serious cases or cases in the beginning stages may be treated with physical therapy, NSAIDS, heat/cold compresses, light stretching exercise such as yoga, non-opioid analgesics, acupuncture, massage, and chiropractic care.
If these methods do not provide relief from pain you may need stronger, opioid medications. Facet joint injections are another method for more serious cases. If the injections fail to provide relief a more invasive method such as nerve ablation or surgery may be necessary (Radiofrequency treatment has a beneficial role in reducing low back pain due to facet syndrome in octogenarians or older 2014).
What are expectations when a patient gets treatment?
Depending on the severity of your condition and how well you respond to the treatments, you may experience relief from your pain from one or more of the treatment options. Many patients are able to control or manage their pain with non-invasive methods without having to resort to surgery.
How is the procedure/treatment performed?
Prescribed physical therapy will be performed on an outpatient basis utilizing light, low impact stretching and strengthening exercises designed specifically for you. Minimally invasive treatments such as nerve ablation and facet joint injections are also performed on an outpatient basis.
Facet Joint Injection
This procedure takes about half an hour. You will be placed on an examination table and have your vital signs monitored. The area to be injected will be cleansed with antiseptic solution then numbed with a topical anesthetic. A needle will be inserted with fluoroscope (a type of x-ray machine) guidance to ensure proper needle placement.
Contrast dye is usually injected to ensure the correct nerves are being treated, after which a mixture of local anesthetic and corticosteroids are injected. Often the patient will experience immediate relief merely from the local anesthetic, but this wears off in a few hours. After the injection the patient is placed in an observation area for 30 minutes to watch for adverse reactions.
Radiofrequency Nerve Ablation
This procedure begins similarly to the injections, but rather than medications being
injected, a small needle is inserted into the area near the nerve and an electric current creates heat and in effect burns off the nerve thus ending the signal of pain to the brain.
How long do the treatment last with this condition?
Therapy and medication treatments are short duration and must be repeated to maintain the benefit. Injections may require repeated treatments to achieve maximum benefit and can last for several weeks, to several months. Nerve ablation can also provide long term relief, often for several years.
What risks or side effects are there?
Physical therapy, non-opioid analgesics, acupuncture and other similar non-invasive treatments have very minimal to no risk; although soreness is common after a session and anti-inflammatory medications may irritate the stomach. Patients taking opioid analgesics are at risk of developing dependency or even addiction to the narcotic if the medication is abused.
Facet joint injections have a few minor side effects, these include bruising and swelling in the injection area, light bleeding (just a drop or two) at the injection site, tissue deterioration from the steroid over a period of time if the same location is injected repeatedly, and there is a small risk of infection if the injection site is not kept clean until it heals.
Nerve ablation risks may include damage to surrounding tissue (although rare). Surgical procedures carry the risk of scarring, scar tissue developing in the procedure site, nerve damage, and FBSS (failed back surgery syndrome) (Effect of adding cervical facet joint injections in a multimodal treatment program for long-standing cervical myofascial pain syndrome with referral pain patterns of cervical facet joint syndrome 2012).
How successful are they for the relief of pain for facet syndrome?
People react differently to different treatments and medications so your results cannot be anticipated, however most people will experience relief from one or more of these procedures. Discuss with your Chicago pain management specialist to determine which procedure might be right for you.
The Chicago pain management doctors at Premier Pain & Spine have extensive experience for the treatment of back and neck pain due to facet syndrome and arthritis. This includes both medical and interventional Chicago pain management.
There are 7 Chicago pain clinic locations, call (847) 519 4701 for more information and scheduling today!