FACET JOINT PAIN
The facet joints, technically known as zygapophysial joints, are small, paired joints of the spine. They are movable connections that, along with the discs, provide structural stability to the spine, while at the same time allowing for movement. These joints have cartilage and a small amount of fluid, just like the many other joints of our bodies, such as the knees. They can be a source of neck, middle, or low back pain.
The diagnosis of facet joint pain can be difficult, but can be initially made through an examination with a spine specialist, who can look for important historical, physical exam or imaging clues to the disorder. This needs to be differentiated from pain arising from the nerves, discs, muscles or other structures of or near the spine. The diagnosis can be confirmed through the use of an injection procedure where the small nerve branches to the facet joints are numbed through a procedure called medial branch blocks.
Conservative treatment of facet joint pain includes the use of postural correction, manual physical therapies, and medication management, including the use of anti-inflammatory medications or supplements. An individualized exercise program will enhance awareness and maintenance of proper posture and spine alignment.
Interventional procedures (injections) can be used to treat facet joint-generated pain. Facet blocks can be done by injecting a local anesthetic or numbing medicine, along with a corticosteroid, into the joints. This can assist in diagnosis. This may occasionally result in prolonged pain relief and return to a higher level of function. When facet blocks result in sustained pain relief and improved function, some insurance carriers will allow for repeat facet joint injections. These facet blocks can be used, also, as the first stage in the diagnostic process.
When the diagnosis of facet joint pain is made using injections of the medial branch nerves to the facet joints, then an additional treatment, called radiofrequency ablation of the medial branches, can be offered. The stronger the response to medial branch blocks, the better the prognosis for the outcome from RF ablation, or neurotomies, is. RF procedures can result in sustained pain relief of 6, 12 or more months. There can be significant soreness at the procedure site initially, lasting days or weeks. This can be treated with medication management and the use of topical agents immediately following the procedure.
A detailed description, with references, of the diagnosis of facet joint pain and the selection of patients for radiofrequency (RF) ablation of the medial branch nerves that innervate the facet joints can be found in the subject review: The Selection of Patients for Lumbar RFN.
In general, facet joint pain is a treatable condition that first requires accurate diagnosis and treatment by skilled practitioners.
The images below illustrate the cervical and lumbar spine, with the images rotated to present a good view of the facet (zygapophysial) joints.