Facet Joint Syndrome Diagnosis & Treatments
How Do We Diagnose Facet Joint Syndrome?
Accurate and thorough diagnosis is key to selecting the best treatment options. The following is part of a comprehensive diagnostic workup:
- Medical history: Assessment of symptoms, previous treatments and care.
- Physical examination: A careful examination by a spine specialist for limitations of movement, problems with balance, and pain. The examination should also cover loss of reflexes in your extremities, muscle weakness, loss of sensation or signs of spinal cord damage.
- Diagnostic tests: Generally, plain x-ray films are taken which allow the physician to rule out other problems such as infections. CT scans and MRIs are often used to give them a three-dimensional view of the lumbar spine and can help detect herniated discs.
What Are The Treatment Options?
A number of non-surgical and conservative treatment options can be done to improve chronic facet syndrome or axial back pain. Many of these treatments can bring temporary relief and in some patients significant relief.
- Modifying daily activities to reduce stress on the back muscles
- Medications: anti-inflammatories, muscle relaxers and, on rare occasions, narcotic pain killers
- Heat/cold therapy
- Physical therapy Exercise: including stretching, massage, and strengthening
- Medial branch blocks or facet joint epidural steroid injections are used two-fold; first, to relieve inflammation of the affected spinal nerve and secondly, diagnostically to confirm the correct affected level from which the pain originates.
Least Invasive Spine Procedures
When conservative care is not enough and the symptoms become chronic and exist for more than 3-6 months, then interventional and diagnostic injections and procedures may help.
In patients suffering from facet mediated back or neck pain, a physician will diagnose the patient with this condition through a physical examination, radiographic studies and a confirmatory facet medial branch block injection. If the patient has greater than 50% pain relief, they typically are a good candidate for a traditional percutaneous radiofrequency rhizotomy.
- Radiofrequency Ablation – During a percutaneous rhizotomy, a probe is inserted through the skin under X-ray guided image allowing for indirect visualization to target the medical branch nerve. The patient can elect to have sedation or not depending on their tolerance for procedures. The probe is then heated thus attempting to ablate the small nerve and relieve pain. The clinical results for a percutaneous rhizotomy are: 70% of patients get relief from their back or neck pain
for 3 months up to 1 year.
- Endoscopic Rhizotomy – With conscious sedation, a 7mm tube is inserted under X-ray image to the facet and a working channel endoscope with HD camera is inserted into the tube. Under direct visualization, the physician ablates the medial branch nerve with a radiofrequency probe and pulls the nerve apart. The results in clinical literature have suggested about 80% of patients have experienced 50% or more reductions in the back pain relief for up to 5 years. The endoscopic approach affords clinically superior longevity when compared to published results of radiofrequency ablation. *
Minimally Invasive Spine Surgery
- MIS Microdiscectomy – Usually an open procedure or using tubular retractor with an incision of 1 inch. The surgeon usually observes through a microscope or set of eyeglass loupes that help magnify the anatomy. Most of the pain post-operative is from the approach the surgeon made through muscle in your back. Anesthesia is necessary.
- MIS TLIF – The surgery involves removing the damaged intervertebral disc and replace it with a piece of bone or PEEK cage packed with bone to assist in union or fusion of the two vertebral bodies over time. Screws are used to hold the disc still until it fuses.
* Five Year Long-Term Results of Endoscopic Dorsal Ramus Rhizotomy and Anatomic Variations of the Painful Lumbar Facet Joint; Farhan Siddiqi, MD, Presented at 2013 SMISS Annual Conference