FACET JOINT SYNDROME

Cause

The facet joints, or zygapophysial joints, are small joints in the spine. Formed where two vertebra come together, they prevent excessive twisting of the spine while allowing a small amount of lateral bending, flexion and extension. Their function can be disrupted by degeneration, dislocation, fracture and/or instability of the facet joints from trauma, osteoarthritis or surgery. This disruption affects a small nerve called the medial branch that provides sensation to these joints, resulting in a painful condition called facet joint syndrome.

There are two ways to treat this syndrome, and both are described here. These procedures can be painful, so every effort will be made to minimize discomfort. Please feel free to discuss any questions with your doctor before undergoing treatment.

Treatment

Facet joint injection/medial branch block

This procedure diagnoses and temporarily relieves symptoms from facet joint syndrome. Performed in an operating room under sterile conditions using X-ray guidance, small needles are placed in the location of medial branch (medial branch blocks) or into the joint itself (facet joint injections). After confirming proper placement, local anesthetic solution and a small amount of steroid is injected.

Because iodinated contrast medium is used, let the doctor know if you are allergic to iodine or shellfish.

If the pain is the result of facet joint syndrome, the injection should result in immediate relief. Patients are examined in the recovery room and again two weeks later to assess the level and duration of pain relief. If it is adequate, the doctor will discuss various long-term treatment options.

The duration of pain relief varies. The medial branch nerve will regrow over time, causing the pain to return. When this happens, the procedure may be repeated.

Radiofrequency ablation

Radiofrequency ablation is successful for 80% of patients diagnosed with facet joint syndrome. Small hollow needles, or cannulas, are placed near the medial branch. Using X-ray guidance in sterile operating-room conditions, a probe is inserted through the cannula. After proper placement is confirmed, local anesthetic solution is injected. The nerve is then heated using radiofrequency waves, in a similar fashion as a home microwave oven.

Typically, patients experience soreness for 1-2 weeks while the nerve is dying. After the nerve dies, the pain should subside. The duration of pain relief will vary, and typically lasts 8-12 months. Because the medial branch does regenerate over time, pain will return to the site, requiring the procedure to be repeated.

Within 72 hours of the procedure, stop taking aspirin, anti-inflammatory medication (Motrin, Advil, Aleve, ibuprofen, Celebrex, Naprosyn, naproxen, ketoprofen, Feldene, Indocin, Relafen, Mobic), and blood thinners (Coumadin, Aggrenox, Plavix, heparin, Lovenox). Avoid food or drink after midnight the night before. Please let your doctor know if you have an allergy to iodine or shellfish before beginning the procedure.