Low Back or Neck Pain Consider Facet Joint Syndrome
posted by : Dr. Barnetton: 23 September, 2019
The usual flexibility of the spine is in part due to the motion allowed by intact discs anteriorly, and the Facet joints in the posterior part of the spine. Facets, or Zygapophaseal joints are synovial joints, not unlike other joints, with cartilage, capsules, synovial fluid and small ligamentous structures. I often equate them to the fingers joints and remind patients of the results of catching a ball on the end of their finger. They bear only 30% of our spines load when we are young, and as we gradually shorten and have years of wear and tear, they bear 70% of the load by age 70. Of course, anything that deteriorates our discs, thus flattening them or any rigidity, (think alignment, stiffness, or fusion) prematurely shifts the load in the spine to the “posterior elements”, the facet complex. The spine is subject to extension injuries. In the neck think of whiplash. Once injured they age faster, often producing pain with movement with resulting local muscle guarding and stiffness. The muscles in turn compress local nerves producing pain, head-Ache, pectoral spasm with Thoracic outlet symptoms of numb arms and hands.
Injection of local anesthetic and steroids can produce short-term relief, and are usually reserved for more acute cases.
Anesthetizing the nerve to the joint, (medial branch), isolates a joint and is purely diagnostic for about 6 to 20 hours. If 80% successful in relieving pain each time one then qualifies to have a Rhizotomy during which that same nerve is disconnected for 1 to 2 years in the neck and thoracic spine. This is a very safe and simple procedure taking less than 30 minutes in the office or surgicenter if your insurance dictates their preferred location.