Evaluating facet joint pain
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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The lumbar facet joints can be a source of significant low back pain.
Facet joints are located on the back of the spinal column and help the vertebrae interact. Articular cartilage covers the surfaces of the facets. Just as with other joints in the body that are have articular cartilage, the lumbar facet joints can be affected by arthritis.
There are two facet joints between each pair of vertebrae, one on each side of the spine. The alignment of the facet joints of the lumbar spine permits movement as a person bends forward and backward and side to side.
Normally, the facet joints fit together snugly and glide smoothly. With arthritis, cartilage wears away.
Rubbery discs separate the vertebrae from each other in front. As a disc thins with aging and from wear and tear, the space between two vertebrae shrinks. This leads to a situation where the space between facet joints begins to narrow as well.
Facet joint arthritis develops slowly over a long period of time.
Pain from facet joint arthritis is usually worse after resting. Also, trunk movement sideways or backward usually reproduces pain on the same side as the arthritic facet joint.
Pain may be felt in the center of the low back and can spread into one or both buttocks. Occasionally, the pain radiates into the thighs, but it rarely goes below the knee.
Symptoms of nerve compression can sometimes occur in addition to the pain from facet arthritis. Bone spurs may form in the opening where the nerve root leaves the spinal canal. If the spurs irritate the nerve root, the nerve can become inflamed. Symptoms include numbness, tingling, abnormal reflexes, and muscle weakness.
A diagnosis starts with a history and physical examination.
When more information is needed, the doctor will order magnetic resonance imaging (MRI) or CAT scan. These tests gives a clear picture of the facet joints to see whether they are possibly the cause of the pain.
A diagnostic injection may be used to locate the source of pain. The doctor uses a needle to inject a local anesthetic into the joint using fluoroscopy or ultrasound guidance. The results from the injection help the doctor make the diagnosis. If pain goes away, it helps confirm the source of pain.
Facet joint arthritis is mainly treated non-surgically. Doctors may prescribe rest.
The doctor may prescribe anti-inflammatory medications. Muscle relaxants are occasionally used to reduce muscle spasm.
Patients may be referred to a physical therapist.
Spinal manipulation can sometimes provide short-term relief of pain from facet arthritis.
Patients who still have pain after trying various treatments may require injections into the facet joint or the small nerves that go to the joint. Steroids are occasionally used along with the anesthetic. This procedure has some good short-term results with few side effects.
Radiofrequency ablation- burning the nerves supplying the facet joints using high frequency radio waves- is sometimes done by pain management physicians.
People with facet joint arthritis rarely need surgery. However, facet joint arthritis is a primary source of chronic low back pain about 15 percent of the time. After trying other types of treatment, some patients may require surgery. There are different types of surgery for facet joint arthritis. The two primary operations are:
• facet rhizotomy
• posterior lumbar fusion
Facet rhizotomy is a procedure where the small nerves that supply the facet joint are destroyed.
Posterior lumbar fusion is a procedure where vertebrae are joined together. This keeps the bones and painful facet joints from moving.
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