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
facet median branch block with local
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..