Facet joint syndrome commonly presents as axial back pain with little radicular or sciatica symptoms. It was reported in clinical research that some of the chronic low back pain where cause is not apparently, this pain may be contributed by facetal arthropathy. The incidence is up to 40%.

Facetal arthropathy cannot be diagnosed by Xray or MRI investigations. After failing conventional measures, a diagnostic facet joint injection is usually performed. If the injection produces significant but short term pain relief, denervation of the facet joint can be performed to eliminate the painful sensation from the joints and thus provide long term pain reduction (in 80% of cases). In some cases, the therapeutic denervation procedure may be done immediately if Before performing denervation, however, a diagnostic facet joint nerve block with local anesthetic may be carried out. By blocking the nerve branches, the brain no longer receives the painful signals from the damaged facet joint and therefore, temporary (2 to 4 hours), pain relief is achieved. As the local anesthetic effect wears off in 2 to 4 hours, the usual pain returns. If the block reduces the pain transiently by at least 50%, the block is considered positive and denervation is usually scheduled. If the blocks reduce the pain less than 50%, most experts consider the results to be "nonspecific" and usually will not proceed with the deadening nerve procedure (denervation).

The denervation procedure is carried out using a Radio-Frequency (RF) denervation (ablation) technique. A RF needle is inserted and the tip is directed to reach the nerves coming from the facet joints under X-Ray guidance. Sensory and motor tests are then performed to insure proper placement of the RF needle on the nerve. Denervation of each nerve is carried out at 80 degrees for 90 seconds.

Complications from the procedure are rare, but most people experience transient local muscle pain and spasm (this may last 2 to 5 days or even longer). The benefit from denervation may last forever (>80% of cases) or 6 to 8 months (< 20%). Denervation may be repeated in 6 to 8 months for those whose nerves regenerate and a similar pain returns. Please see the radiofrequency link for more specific questions and answers.

If denervation only partially reduces the pain, then, the residual pain is usually coming from chronically damaged ligaments/tendons, dysfunctional sacroiliac joints or degenerated discs. Prolotherapy may be a helpful adjunct to therapy by strengthening ligaments/tendons and tightening the loosened or distorted joints. This then results in less pain and greater function. Periodic sacroiliac joint injection with steroids may also significantly reduce chronic sacroiliac joint pain.

Facetal pain has been reported to be as common as up to 40% in axial low back pain, where all other causes have been excluded. Facet joints (also called zygopophyseal joints) are small joints behind the discs which help to support the spine and allow it to move. Facet joint surfaces are lined by cartilage. The facet joint itself is wrapped by a thick fibrous capsule that holds the joint in the proper alignment and gives it strength. Each facet joint receives innervation from the spinal nerves, which send sensory information from the facet joint to the spinal cord and then to the brain. If the facet joint is arthritic or otherwise irritated, these can become painful, hence presenting as low back pain with/out referred pain in legs.

Facet joints are susceptible to trauma and wear-and-tear changes. Whiplash injuries, a sudden jerk of the neck, twisting while lifting overhead, or unguarded rotational motion of the spine, may lead to joint capsular tears, irritation of the joint surface, or distortion of the joint alignment can give rise to facetal arthropathy. Daily wear-and-tear changes of facet joints can be caused by cartilage loss or spinal disc degeneration. In this case, the height between the vertebrae is diminished as the disc collapses, which results in abnormal loading forces on the facet joint at that level.

Neck Arthritis

Cervical (neck) facet syndrome may cause neck pain and cervicogenic headaches. These may present as upper neck pain with headache at the base of the skull, aching behind the eyes, ringing in the ears, and upper limb tenderness. Extension and rotation of the neck usually aggravates the symptoms. Facet syndrome in the lower neck region may manifest itself as pain and tenderness in the neck, shoulder and upper back, loss of cervical spinal curve, and is usually aggravated by neck extension and rotation.

Upper Back Arthritis

Thoracic (middle back) facet syndrome may cause mid-back pain with muscle spasm, and loss of the normal thoracic spinal curve or occasionally pain encircling the rib cage. The pain is usually aggravated by spinal extension and rotation.

Lower Back Arthritis

Lumbar (lower back) facet syndrome usually leads to achy/sharp/throbbing pain in low back, buttocks, hips and occasionally hamstrings, associated with muscle spasm of the back muscles on the same side. The pain is usually aggravated by pressing over the facet joints or simultaneous extension and rotation of the lumbar spine. This pain must be differentiated from sacroiliac pain, which can be in a similar distribution.

Modalities of Treatment

Treatment of facetal arthropathy includes conservative measures such as local heat, traction, lumbar corset, anti-inflammatory medications (NSAIDS), muscle trigger point injections, acupuncture, physical therapy and manipulation.

Interventional pain procedures such as facet joint blocks, dorsal median branch nerve blocks or denervation and prolotherapy are helpful in controlling the back or neck pain. Unfortunately, there has not been a curative treatment for arthritis itself. If the injection produces significant pain relief, denervation of the facet joint can be performed to eliminate the painful sensation from the joints and thus provide long term pain reduction (in 80% of cases).

Radiofrequency ablation is likened to applying a laser on the facet joints to “burn” off the painful nerves. It is not harmful to other non-painful nerves, if applied appropriately. The RFA is directed through a needle into the facet joints, under Xray guidance. Each facet joint is innervated by 2 medial branches sensory nerve. Two lesions are made at each facet joint. Sensory and motor tests are then performed to ensure proper placement of the RF needle on the nerve. The principle of this procedure is to cause a “functional” neurectomy without structurally cutting off nerves. It allows for obliteration of pain and surrounding supporting structures (muscles) to recover. Once the pain cycle is broken, the painful facet joints no longer interfere with the patients’ activities (effect similar to wearing a lumbar corset).

Complications from the procedure are rare, but most people experience transient local muscle pain and spasm from the injection sites (this may last 2 to 5 days or even longer). The benefit RFA may last for years (>80% of cases) or 6 to 8 months (< 20%). Denervation may be repeated in 6 to 8 months for those whose nerves regenerate and a similar pain returns.

There are occasions where RFA only partially reduces the pain, then the residual pain is usually coming from chronically damaged ligaments/tendons, dysfunctional sacroiliac joints or degenerated discs. Prolotherapy may be a helpful adjunct to therapy by strengthening ligaments/tendons and tightening the loosened or distorted joints. This then results in less pain and greater function. Periodic sacroiliac joint injection with steroids may also significantly reduce chronic sacroiliac joint pain.

Before performing RFA, a diagnostic facet joint nerve block with local anesthetic may be carried out. By blocking the nerve branches, the brain no longer receives the painful signals from the damaged facet joint and therefore, temporary (2 to 4 hours), pain relief is achieved. As the local anesthetic effect wears off in 2 to 4 hours, the usual pain returns. If the block reduces the pain transiently by at least 50%, the block is considered positive and denervation is usually scheduled. If the blocks reduce the pain less than 50%, most experts consider the results to be "nonspecific" and usually will not proceed with the RFA procedure (denervation).

The denervation procedure is carried out at a separate sitting using a Radio-Frequency (RF) ablation technique. A RF needle is inserted and the tip is directed to reach the nerves coming from the facet joints under X-Ray guidance. Sensory and motor tests are then performed to insure proper placement of the RF needle on the nerve. Denervation of each nerve is carried out at 80oC for 90 seconds.