Facet joints, which are comprised of pairs on either side of the spine, connect the vertebrae at various regions; these include the cervical region, the thoracic region, the lumbar region and sacrum (pelvis). Facet joints provide spine stability and allow spine movement and flexibility.
Facet joints are also the main source of back pain for many sufferers. Depending on where the problematic joints are located, they can also be the source of pain in many other parts of the body—such as the abdomen, buttocks, groin, legs, neck or shoulders. Problems with cervical facet joints can even cause headaches. However, facet joint pain most commonly occurs in the lumbar and cervical spine regions.
Facet joint syndrome is a type of arthritis of the spine. It is caused by the degeneration of the cartilage inside the facet joints, resulting from years of wear and tear. This causes inflammation and triggers pain signals in surrounding nerve endings.
While facet joint pain is more common in older people, it can also occur among the young. Painful facet joints are the cause of 10 to 20 percent of all long-term back pain, and up to 40 percent of back pain in those over 65 years old.
The pain tends to be worse with activity and abates at night. It is an aching, dull pain and often radiates from the back into the buttocks and thighs. Thus it can be mistaken for sciatica.
When other conservative methods, such as medication, physical therapy and pain injections cease to provide relief, a pain management specialist may recommend a facet joint rhizotomy. This minimally invasive, non-surgical procedure essentially severs the nerves that are sending spine pain signals to the brain, thus disabling those nerves. In addition to pain relief, some patients also have improved function; they can walk and do their everyday activities more easily.
How is Facet Joint Rhizotomy Performed?
A facet joint rhizotomy is performed in an outpatient setting, such as an ambulatory surgery center or medical office. A mild sedative is administered intravenously (through an IV), with a local anesthetic used to numb the site of the injection. Before a facet joint rhizotomy, the specific facet joint nerves (medial branch nerves) are identified by the use of a diagnostic injection, called a medial branch block.
A fluoroscopy, which is a real-time X-ray, is used to guide the pain management physician to the correct needle placement area. A probe is inserted right outside the joint. That probe, or electrode, is heated with radio waves and then applied to the specific sensory nerve causing pain in order to disable it. This effectively prevents this nerve(s) from carrying pain signals to the brain.
What is the Recovery?
Following the procedure, which takes about 30 to 60 minutes, patients are monitored for a short time before they are released. Initially, there may be some discomfort following the procedure. This may entail soreness, swelling or bruising at the site of the injection.
If soreness persists, patients may be instructed to use an ice pack or over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) for relief of symptoms. Despite these symptoms, however, most people can return to normal activities a day after a facet joint rhizotomy.
It may take some time before the desired pain relief takes effect until the nerves have completely died. This timeframe could be from a few days to a week or up to three to four weeks following the procedure. In the meantime, occasionally people may experience some minor weakness in the back or neck.
Does the Pain Come Back?
Often, a facet joint rhizotomy provides pain relief that lasts for months, and in some cases, even years. The range of time is due to the fact that the long-term effect of the medication is unpredictable. While the nerves eventually regenerate (grow back), the pain may or may not come back. However, if the symptoms do return over time, it is possible to safely repeat the procedure to provide similar pain relief.
For more information on facet joint rhizotomy or to schedule an appointment, contact us today.