Facet Joint Arthritis
Facet joint arthritis is the wearing down of the joints between the bones of the spine, called facet joints. There is cartilage on the inside of these joints to provide shock absorption and protection of the joint. This cartilage can wear down and become inflamed, causing pain in the facet joint.
What’s in this section?
Signs and symptoms
Common symptoms of facet joint arthritis include:
- Dull, achey and widespread pain
- In the low back
- In the shoulders and back of the skull
- Worsens with movement, standing or inactivity
- Better with sitting, changing positions or learning forward
Diagnosis
Diagnosis of facet joint arthritis starts with a physical exam and medical history. Other procedures and tests may be needed to diagnose this condition, including: x-rays , computed tomography (CT) or magnetic resonance imaging (MRI).
Facet joint injections are an interventional pain procedure used to diagnose and treat arthritic pain originating from the joints in the spine. A small needle is advanced with the help of a fluoroscopy or x-ray machine. Brief x-rays are taken to help direct the needle to the correct location. A small amount of local anesthetic and possibly steroid are slowly injected in the appropriate location.
Treatment options
There are several treatment options depending on the severity of your symptoms:
- Medication to control pain.
- Physical therapy to strengthen the muscles around the spine.
- Steroid joint injections. This is an interventional pain procedure used to treat arthritic pain originating from the joints in the spine. A small needle is advanced with the help of a fluoroscopy or x-ray machine. Brief x-rays are taken to help direct the needle to the correct location. A small amount of local anesthetic and steroid are slowly injected in the appropriate location.
- Radiofrequency ablation (rhizotomy) .This is a procedure where high-frequency radio waves are used to generate heat and cause a lesion along a nerve that supplies sensation to a joint in your spine. This procedure is done after diagnostic lumbar facet joint/medial branch blocks have correctly identified the location of your arthritic spinal pain. All nerves regenerate over time, so the results will not last forever, however, many patients experience pain relief that lasts sox months to over a year. This procedure typically takes about 20 – 30 minutes and may be performed with local anesthetic, oral sedation or IV sedation in the surgery center, depending on patient preference. The procedure involves a special needle that is advanced to the target area under fluoroscopic (x-ray) guidance. A small about of electrical current is then utilized to demonstrate proper placement along the targeted nerve. You will feel a buzz or tapping sensation, but it typically isn’t painful. Once the needle has been properly placed, a local anesthetic will be placed into the targeted area. The radiofrequency ablation, which typically lasts a few minutes, will then be performed. A combination of local anesthetic and injectable steroids is then injected before the needle is removed.
- Minimally invasive fusion. If other treatment options do not provide relief, a spine fusion may be recommended. There are many different techniques for performing a minimally invasive lumbar fusion. The surgery can be performed going through the front underneath the belly button, from the side underneath the rib cage or from behind. Minimally invasive surgery through the lower back typically means dilating a small pathway through the muscles rather than stripping the muscles away from the bones of the spine. There are special retractors designed to protect the muscles and cause less damage to these tissues while performing the same operation.
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