Facet Syndrome and Treatments

The facet joints are the articulations or connections between the vertebraes in the spine. They are like any other joint in the body like the knee or elbow that enable the bending or twisting movements of the spine. The facet joints can get inflamed secondary to injury or arthritis and cause pain and stiffness. When the facet joints are affected in the neck or cervical spine it typically causes pain in this area as well headaches and difficulty rotating the head while in the lower back or lumbo-sacral area, will cause low back pain.

The facet joints are  joints with a synovial lining, the surfaces of which are covered with hyaline cartilage, which is susceptible to arthritic changes and arthropathies. Repetitive stress and osteoarthritic changes to the facet joint can lead to facet hypertrophy. Like any synovial joint, degeneration, inflammation, and injury can lead to pain with joint motion, causing restriction of motion secondary to pain, and thus deconditioning. In addition, facet arthrosis, particularly trophic changes of the superior facet, can progress to narrowing of the neural foramen

Treatment of facet syndrome involves physical therapy with initial treatment plan for focused on education, relative rest, pain relief, maintenance of positions that provide comfort, exercises, and some modalities. Physical therapy includes instruction on proper posture and body mechanics in activities of daily living that protect the injured joints, reduce symptoms, and prevent further injury. Positions that cause pain are avoided. Bed rest beyond 2 days is not recommended because this can have detrimental effects on bone, connective tissue, muscle, and the cardiovascular system. Thus, activity modification, rather than bed rest, is strongly recommended. Modalities such as superficial heat and cryotherapy also may help relax the muscles and reduce pain. In addition, medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), Muscle relaxants can also be administered. At this point, spinal manipulation and mobilization can also be attempted to reduce pain.

When the above fails, injections including facet joint injection (now almost obsolete), facet median branch block with local anesthetics, prolotherapy, radiofrequency ablation of the facet median branch nerve could be performed .

The radiofrequency needle's tip is directed to the nerves supplying from the facet joints using flouroscopic guidance. Sensory and motor tests are then performed to insure proper placement of the radiofrequency needle on the nerve (According to Dr. Sluitjer in a coversation with him at the World Pain Forum in Barcelona, 2004, this may not be necessary as the old method of using 80oC is now obsolete). Using the Pulse mode, denervation of each nerve is carried out at 42oC for 180 seconds. Relief after the radiofrequency could last from 3 months to 18 months with a success rate of about 80% in the neck and 60-70% in the lower back..





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