Lumbar Facet Joint Pain and Spinal Injections
Part 2 of 3: Facet Joint Pain, Causes and Spinal Injections
The spine’s posterior joints, called the facet joints, are another potential pain generator especially if affected by osteoarthritis and bone spurs (called osteophytes). Each facet joint is innervated (fed) by two tiny nerves that branch off the main spinal nerve root. These nerves are called the facet nerves or—medically speaking—the medial branch nerve of the posterior primary ramus.
Facet joints (see illustration below) serve as locks to prevent over rotation of the spine. They also help to hold the vertebrae in place and prevent one vertebra from sliding forward on the vertebra below it; a disorder called spondylolisthesis. In some patients, one or more facet joints may be affected by osteoarthritis, further resulting in joint inflammation and fluid filled joint capsule(s).
Facet joint pain typically presents as low back pain that may worsen as the day goes on. The pain is made worse by motion and performing heavy work. The physician may reproduce the patient’s pain during the physical examination by having the patient bend backward (extension). Such maneuvers increase the load on the facet joints and compresses them together. It is typically painful. For the purpose of accurate diagnosis a pain physician sometimes attempts to reproduce the patient’s symptoms in the exam room with a diagnostic maneuver.
Degenerative disc disease is a spinal disorder that can affect the facet joints too. As the spine degenerates, its structures are changed. For example, one or more discs may flatten (lose their height) and reduce the amount of space between two vertebral bodies. That loss of space brings the facet joints closer together and may lead to their ability to function normally.
Facet Joint Injections and Nerve Blocks
Back pain related to diseased facet joints may be treated with a spinal injection of a steroid medication (a powerful anti-inflammatory) and local anesthetic medication (temporary pain reliever). In Figure 1, a Tuohy needle is inserted into the affect facet joint and used to insert the pain-relieving medications.
The injection offers diagnostic benefits as well as potentially alleviating the patient’s pain temporarily. If the patient’s pain is relieved, the pain medicine physician may recommend a procedure call denervation—simply, denervation stops a nerve’s ability to transmit pain. The procedure can be performed using cold (cryo denervation) or heat (thermocoagulation) utilizing a radiofrequency probe. Depending on your physician’s preference, either procedure may provide more lasting pain relief than a spinal injection.
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