FACET JOINT SYNDROME
Facet syndrome cannot be diagnosed by x-ray, CT scan, MRI, Bone scan, or any other radiology process. It is suspected on physical exam by tenderness directly over the facet joint, experiencing pain on extension (bending backwards), and on your history. The diagnosis is made by injecting a local anesthetic and steroid to the painful area or the nerve that goes to this area. If your pain is relieved by this injection you may benefit from another procedure called Radiofrequency Rhizotomy/Neurolysis.
Because facets are joints, they can develop arthritis due to injuries, excessive bone formations, thickening, damage to the fibrous capsule that surrounds the facets, or damage to the cartilage inside the joints.
Certain types of activity may encourage the development of facet syndrome. If you are over 45 or your job has involved lifting for a number of years you are more likely to develop facet syndrome. Whiplash injuries are commonly caused by facet joint syndrome.
WHAT ARE FACET JOINTS?
Facet joints link the bones of the spine together in the posterior (back) part of the spine. Two facet joints are present at each spinal segment. They are named for the spinal bones which they connect. For example, in the neck (cervical spine) the facet joints between Cervical #5 and Cervical #6 are called Cervical 5-6. The facet joints are important in restricting the motion of the cervical and lumbar spine. They allow motions of twisting, flexion, and extension.
WHY DO FACET JOINTS CAUSE PAIN?
Facet joints are possible sources of neck (cervical) and lower back (lumbar) pain. A small nerve that branches out from a spinal nerve provides sensation to the facet joint. Trauma or arthritic changes can cause the release of pain generating substances that sensitize the nerve endings located in the joint.
Facet joints can cause pain in one or both sides of the low back. It can be made worse with extension (bending backwards or twisting). The pain can also travel to the buttocks or back of the thighs.
Patients with facet joint pain from the neck (cervical spine), can have neck pain, headaches, shoulder pain or shoulder pain.
WHAT IS A FACET JOINT BLOCK?
A facet joint block involves the injection of a medication into or next to the facet joint. In a diagnostic block, a local anesthetic is used to determine if the injected area is causing the pain. In most cases a steroid is also injected. The purpose of facet joint blocks is twofold. The first is as a diagnostic block. If the patient receives 50% or greater reduction in pain relief for at least 2 hours, there is an increased probability that the facet joint is an important component in the patient’s pain syndrome. The block may then be repeated to confirm the diagnosis. The second purpose of the facet block is to reduce pain. Steroids are injected to help reduce the pain secondary to irritation.
DO THE INJECTIONS HURT?
Patients undergoing facet joint injections may receive an anesthetic medication. This medication will be given in order to relax you. When you awaken from the procedure, you may feel some tenderness where the injections were placed and an ice pack may be placed on your back for temporary relief of this discomfort. The steroid which the physician injects around the facet joint may take 3-7 days to take effect. If the injection does not help, then the facet joint may not be the only source of your pain.
The patient will follow up with the physician on the next scheduled office visit to determine if additional procedures may be needed for more permanent pain relief.