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Facet Arthropathy



What is Facet Joint Pain?

Facet joints are the small joints in the back of the spine from the neck to the low back at each vertebral level which gives patient’s their mobility. We may develop inflammation of the joints, arthritic changes, or tears of the ligaments that hold the joint together, all which can cause pain.


What are the symptoms of facet joint pain?

Facet joint pain typically involves pain at the facet joint itself which radiates above and below the affected levels in specific distribution patterns. The pain is sharp in nature and is worsened with activities which involve extension and rotation of the spine.


How is facet joint pain treated?

Once diagnosed, facet joint pain can be treated in a multitude of ways including facet joint injections, as well as rhizotomies which involves targeting and treating the sensory nerves that relay the pain signal from the joint to the brain. This is done by heating the nerve to where it can no longer relay the pain signal to the brain without affecting normal muscle functioning. We have also been successful injecting PRP (platelet rich plasma) into the facet joints giving long lasting pain reduction.


Am I a candidate for a facet joint injection?

Facet mediated pain has been implicated as the source of patient’s axial discomfort (located around the midline of the spine) in 20-45% of patients with low back pain, 50% of patients with the thoracic pain, 50-70% of patients with cervical pain.  When these joints are irritated, they not only causes discomfort related to the joint itself, but also cause the muscles on the sides of the spine to spasm.  The injection is performed with a combination of local anesthetic and steroid.  The local anesthetic will numb the joints quickly, which allows us to confirm that this is the pain generator if the patient’s discomfort resolves prior to leaving the facility .  The steroid provides longer-term relief for the inflammation of the joint and its capsule.


What are the benefits of a facet injection?

Facet injections can tell us if the patient’s discomfort is due to arthritis or ligament tears of the joints in the back of the spine.  They can also speed the healing process of ligament tears.


How long this is a facet injection take?

Approximately 5-15 minutes depending on the number of joints that are treated

How is a facet injection performed?

The patient is placed in the prone position on the procedure table (facedown).  All patients are monitored with heart rate, blood pressure and an oxygen monitoring device.  The skin overlying the treatment area was cleaned with an antiseptic solution and number with local anesthetic.  The the injection needle is then placed under live x-ray (fluoroscopy) guidance into the joint.  Once the needle was in the correct position, the medication will be injected.  The needle was then removed and a Band-Aid is applied.  The patient has been asked to perform activities that are normally unpleasant to do approximately 10-15 minutes afterwards to determine whether the facet was in fact the source of the patient’s discomfort.

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