- The facet joints are the two additional joints
that are not talked about as much
when we're talking about spine problems.
Patients come in and always
want to know how their discs are doing.
And the discs are very important.
But the facet joints
are a very interesting nidus of pain.
A lot of discomfort can come
from the lower facet joints
that can create very debilitating back pain.
The facet joints can be injured
a couple of different ways.
These facet joints can be injured
in a type of whiplash type of injury.
And in the lower back rotational injuries
can injure these facets.
And usually what happens is that these facet joints
degenerate similar to the discs themselves
in the fact that arthritis can affect these joints.
So as we get older on in life,
the injuries to the lower back
can continue to cause micro trauma
to these little hinge joints that we have in our back,
and we have at every level of our lower backs,
one on each side.
So the most common complaint is
stiffness in the morning.
Sometimes the mobility throughout the day
makes them feel better.
But in general, standing for long periods of time
causes significant discomfort
that sits just right there in the lower back
where the facet mediated pain is.
And sometimes you can have
the referred pain into the legs as a result of that.
But it's usually alleviated when you sit.
Typically with facet mediated pain
on the initial evaluation
we're doing an exam localized
to try and push on the facets themselves
and see if that causes discomfort.
We have the patient lying down on their stomach.
In addition, the other component is functionally,
standing upright
and usually extension where the rotational components
can load these facets.
It's not absolute.
It's not a definitive diagnosis with doing this.
But it really can help identify that area
as being the possible cause of the discomfort.
The imaging studies are quite important in the circumstance.
The idea is that on an initial evaluation
you're obtaining x-rays to evaluate,
to make sure that there isn't a dislocation or fracture,
but also to take a look and see
what role the arthritis may be playing
in the patient's problem.
And we can take a look at the facets themselves
and find out, is there a lot of arthritis of these facets.
Now, because facet pain can also radiate
sometimes into the legs,
the idea is that further imaging study,
like an MRI, can be performed,
not only to take a look at the facets,
but also to make sure that the nerves
are not getting impinged before they leave the spine.
Treatment options for facet pain
can include anti-inflammatory medications,
such as non-steroidal anti-inflammatory medications.
Occasionally we do use steroids,
either taken by mouth or we can actually
do injections into these little facet joints.
This has both diagnostic and therapeutic benefits,
meaning that when we do the injection into the facet joint
and we get good pain relief,
that further confirms that this is
where the pain is coming from.
And by doing an injection into the joint
with a steroid as an anti-inflammatory,
that is the treatment.
The idea is that once we get that inflammation
and irritation of the facet down,
then we can progress the patient
into a functional rehabilitation program
to address what causes the degenerative issues
to the facets to begin with.
Inevitably, one option, though,
is that when these facets themselves
are significantly irritated
and the injections themselves
don't always last for a long period of time,
we can do higher level interventional procedures
to identify and burn the actual nerves themselves
that go into the joint
so the patient does not have
discomfort to this joint any longer.
One additional option for facet mediated pain
is to try and decompress this area.
Traditionally we decompress or do traction
on the spine for disc-related issues.
But unweighting that joint temporarily
can help alleviate the pain for patients
so that we can once again progress again
with the physical therapy program.
So intradiscal decompressive therapy
or IDD therapy is essentially the new form of traction.
Traction has come a long way.
We used to admit patients to the hospital for this
and have a big bag of sand or water
at the end of the bed.
And patients would be in traction
for a week or two.
Now everything is high tech, thank goodness,
because we have a suite where we have
a high tech computerized machine
that can actually pull at a very precise angle
to distract the spine right where
either a disc is herniated,
significant degenerative changes exist,
zygapophyseal arthropathy is present,
that's the facet mediated pain.
And by decompressing this area
we can give significant pain relief.
It improves vascularity and healing up
of the damaged tissue in this area.
It's very important that after the patient
gets the initial treatment to try and reduce the irritation
of these facets themselves,
for them to get an education
about what causes these problems.
That's usually the role of the physical therapy.
But inevitably it's very important for the patient
to continue on with their exercise program
that's been very individualized for their problem
so that they don't have problems in the future.