The spinal column—the weight-bearing portion of the spine—is made up of flat, more or less round vertebrae alternating with supportive discs. We wouldn't get very far, though, if these structures were simply stacked up like pancakes. They must be connected somehow, yet remain flexible enough for us to do things like yank crabgrass out of the lawn or pick up Legos off the living room floor. That's where the facet joint comes in.
What’s a facet joint?
On the back side of most vertebrae is a bony structure called the vertebral arch. In its center is a bumpy projection – that’s the part you can feel as you run your fingers down the spine. This little knob sits at the center of the vertebral arch. Pairs of rigid projections extend upward and downward on either side (see the lower-right inset in Figure 1). A facet (fuh-SETT) joint is the point at which the downward projections of one vertebra meet the upward projections of the vertebra below it (see the upper-right portion of the illustration).
A pair of facet joints, then, connects each vertebra to the one below it, giving the spinal column strength and flexibility. Each facet joint is lined with cartilage and surrounded by a fluid-filled capsule that keeps the joint lubricated. Inside the capsule are tiny offshoots of the medial nerve, which relay pain signals to the brain when joint damage occurs. 1
What is facet joint syndrome?
The aging body is like a ’55 Chevy—to remain roadworthy, it must be carefully maintained. As a vehicle ages, rust sets in, rubber gaskets dry out, belts snap. Likewise, facet joint syndrome is a condition in which an arthritic facet joint causes pain and stiffness, reduces range of motion, or limits mobility. Remember, the facet joint may be oddly shaped, but it’s a joint all the same—just like a knee or an elbow, only smaller. Facet joint syndrome can affect any part of the spine – cervical, thoracic, lumbar, or sacral vertebrae – but it’s most common in the lumbar region.
What are the symptoms of facet joint syndrome?
What causes facet joint syndrome?
How common is facet joint syndrome?
How is facet joint syndrome diagnosed?
How is facet joint syndrome treated?
Your doctor will probably encourage you to become more active. But if exercising on your own doesn’t help, physical therapy may be in order. A physical therapist can show you how to target the right muscles and improve your posture and body mechanics to increase your flexibility and range of motion. Physical activity tones the muscles surrounding the facet joints. As these muscles become stronger, they’re better able to support the spine, helping them bear the load of your body weight.
Acetaminophen and antiinflammatory drugs, such as ibuprofen (Advil) and naproxen (Aleve), are often prescribed to reduce the pain of facet joint syndrome. Muscle relaxants can ease muscle spasms associated with arthritic facet joints. Sometimes doctors even prescribe oral steroid medications to tamp down acute pain. They may also prescribe medications to treat the anxiety, sleeplessness, or depression associated with chronic pain.
Prescribed sparingly and monitored carefully, opioid (pain relief) medications are an excellent tool for managing the symptoms of facet joint syndrome. You and your doctor can discuss the risks and benefits of opioid therapy to decide if this option is right for you.
Implantable Drug Pump
Some patients benefit from placement of a pain pump programmed to deliver medication directly into the cerebrospinal fluid (the fluid surrounding the spinal cord). The pump is a battery-operated electronic device surgically implanted into a pocket in the abdomen. It’s attached to a catheter (a long tube) that’s threaded up into the spinal canal to the level of the affected facet joint. The surgeon then verifies correct placement of the catheter using fluoroscopy (a sort of real-time x-ray).
Injection with local anesthetics or corticosteroids
Injecting local anesthetics or steroid medications into the joint space can reduce inflammation and shut down or at least weaken the intensity of pain signals to the brain. To perform the procedure, the physician uses real-time x-ray pictures to guide the needle into the joint capsule. Then the medication is released into the joint space.
Lumbar facet joint injection with autologous platelet-rich plasma (PRP)
Whoa, that’s a mouthful! Let’s break that down. A lumbar injection is, of course, an injection into the lumbar (lower) portion of the spine. The word autologous (ah-TAW-luh-guss) simply means “self.” In other words, this procedure utilizes your own blood plasma, rather than plasma from a blood bank. The phrase platelet-rich plasma (PRP) refers to a blood product containing a high concentration of red blood cells, or platelets. Platelets produce growth factors that stimulate tissue regeneration in the area. To perform an autologous PRP injection, first a small amount of the patient’s blood is collected. Then the platelets are separated from the other blood components to produce a concentrated slurry of red blood cells. In fact, PRP contains 4 to 5 times more platelets than regular (whole) blood. The last step is injecting the PRP into the joint space under x-ray guidance.
Transcutaneous Electrical Nerve Stimulation (TENS)
Transcutaneous electrical nerve stimulation is the application of a low-voltage electrical current through the skin in order to relieve pain. Pads are applied to the skin, and a battery-powered TENS unit is used to deliver mild electrical stimulation to the anatomic structures in the area.
A spinal cord stimulator is a surgically implanted, battery-operated pulse generator that produces a low-voltage electrical signal intended to mask your body’s perception of pain. The device itself is implanted within the abdomen or buttocks. It’s equipped with leads (wires) that extend through the epidural space of the spinal column to the level at which your pain originates.
Neuroablation, also known as rhizotomy, radiofrequency neuroablation (RFA), or radiofrequency denervation, is a procedure in which tiny portions of the medial nerve are deliberately destroyed by applying heat in the form of an electrical current. (Thermoablation, a similar procedure, uses a surgical laser, rather than an electrical current, as the heat source.) Under x-ray guidance, the doctor inserts a tiny electrode into the facet joint capsule, zapping the nerve endings with an electrical pulse. This little jolt damages the nerve, impairing its ability to transmit pain signals to the brain.
If lifestyle modification and procedural interventions provide inadequate relief, or if you’re still having trouble engaging in everyday activities like walking the dog or washing the car, it may be time to consider surgical options. The more cautious the surgical approach, the more successful the outcome, generally speaking. Keyhole spine surgery requires only a dime-size incision, minimizing damage to surrounding nerves, muscles, and other tissues and dramatically reducing the risk of infection. Keyhole surgery is often an outpatient procedure. Compared with more invasive approaches, patients enjoy a much faster recovery. The results speak for themselves. Being able to focus on a movie again, enjoy a pain-free walk at the dog park, or sit comfortably in coach for that 3-hour flight to see the grandkids is the best outcome they could’ve hoped for.
Call Inspired Spine today at 727-MY-SPINE to speak with one of our Patient Care Coordinators.