Understanding Facet Joint Pain and Treatments for the Spine

What are Facet Joints?

The spine, also called the vertebral column, is composed of uniquely-shaped bones called vertebrae. From skull to tailbone, these 33 vertebrae are stacked one on top of the other, and are connected by facet joints. There are two sets of facet joints, also called Z-joints, between each pair of adjacent vertebrae, and they form where the two bones meet.

How do Facet Joints Function?

Facet Joints Stabilize and Allow Movement

Facet joints act as spine stabilizers by limiting movement and keeping vertebrae in place. On the other hand, facet joints also allow the bones of the spine to articulate, or move. A facet joint is lined with cartilage, and surrounded by connective tissue which produces lubricating synovial fluid. This cartilage and synovial fluid allows the two vertebrae to move over each other smoothly.

In this way, facet joints allow the spine to:

  • flex forward
  • extend backward
  • bend side to side
  • twist (rotate)

What Causes Facet Joint Pain?

Specifically, facet joint issues cause pain when the nerves supplying the joints are affected. Facet joints are supplied by medial branch nerves which send pain signals from the spine to the brain. Injury to the spine, inflammation and degeneration of cartilage and connective tissue due to overuse, infection or disease are all potential causes of facet joint pain.

What are Facet Joint Pain Symptoms?

Symptoms will look different depending on the underlying cause of the pain, and what part of the spine is affected.

  • Loss of spinal flexibility (guarding)
  • Joint pain and tenderness
  • Intermittent, unpredictable severe pain episodes
Cervical (Neck) Facet Joint Syndrome:

  • Radiating pain down the neck, upper back, shoulders
  • Headaches
  • Popping/clicking noises when moving head side to side, or up and down
Lumbar (Lower Back) Facet Joint Syndrome:

  • Radiating pain down buttocks and upper leg
  • Popping/clicking noises or “catching” sensations in lower back
  • Difficulty with standing, walking and bending backwards

How are Facet Joint Problems Diagnosed?

In order to prescribe the most appropriate treatment, an orthopedic specialist will need to determine if a patient’s pain is being caused by problems with the facet joints, or if other spinal or muscular issues are to blame. If you are experiencing back pain and symptoms of facet joint pain, consult an orthopedic specialist or your primary care physician.

To obtain a diagnosis, a doctor will gather information through:

  • Patient’s medical history and symptom reports
  • Visual examination of the spine and patient’s range of motion
  • X-rays, magnetic resonance imaging (MRI) or computed tomography (CT) scans of the spine
  • Medial Branch Block: Outpatient therapeutic injection of numbing medicine into medial nerves supplying suspected facet joints. If anesthetizing these nerves results in pain relief, then it is clear the facet joints are the cause of pain. This procedure can be used as a diagnostic tool, and as a treatment.

What are Treatments for Facet Joint Pain?

  • Medication: Over-the-counter (OTC) pain relievers such as NSAIDs, and prescription muscle relaxants and steroids can provide temporary pain relief.
  • Applying heating pads and ice packs
  • Postural adjustments: Changing sitting and standing habits can reduce stress on the neck and back
  • Exercise and physical therapy: Prescribed daily stretches and strengthening exercises improve flexibility and movement integrity. These practices can also relieve pain by increasing circulation and decreasing inflammation.
  • Avoid activities that cause pain: Whenever possible, minimize the amount of time spent performing painful activities, or alter activities to eliminate excessive twisting or bending.
  • Cortisone Steroid Injections
  • Medial Branch Block
  • Radiofrequency Ablation (Rhizotomy)
During this in-office procedure, cortisone (a type of steroid) is injected in the space directly surrounding the target nerve. Cortisone is a natural anti-inflammatory, and these injections help to decrease inflammation, and therefore, relieve the extra pressure on the nerve. Pain relief typically lasts around three months, and during this time, if needed, other measures can be taken to treat the cause of the inflammation.
This method involves a strong local anesthetic being injected onto the medial branch nerves supplying the targeted facet joints. A medial branch block of the cervical or lumbar facet joints is a quick and relatively simple outpatient procedure. The injection itself takes only a few minutes, but the total visit time will likely be closer to an hour with intake and post-procedure observation. The patient will be able to leave the office and resume regular activities the same day, although rest is recommended.

For cervical (neck) medial branch blocks, the injection is typically performed with the patient side-lying. Lumbar (lower-back) medial branch blocks usually require the patient to lay face-down. Before numbing the nerves, the orthopedic specialist will inject an anesthetic into the area superficially to numb the skin and surrounding tissue. This part of the procedure feels like a little pinch and then a slight burning before the area is numbed. The second, and final injection will then feel like a bit of pressure at the site.

Pain relief that lasts between a few hours to a few days is the most common outcome of a medial branch block procedure. Sometimes patients experience an increase in pain from the injection, but this is usually short-lived. Rare side effects include infection, bleeding, and nerve damage. For some patients, this technique is sufficient for pain relief, but typically, the pain relief is temporary. Medial branch block is usually used as a diagnostic tool and then followed up with longer-term pain management.

Targeting the medial branch nerves in the facet joints, this technique essentially severs the communication between the nerves and brain, so that the pain signals are unable to reach the brain. A needle-like electrode, which has been heated by radio waves, or radiofrequency, is used to deaden the nerves determined to be the source of pain. The benefits of radiofrequency ablation include: avoiding surgery, immediate pain relief, little to no recovery time, decreased need for pain medication, improved function, and a quicker return to work and other activities.

The procedure is usually performed in an outpatient special procedure suite that has access to a fluoroscope, or a specialized x-ray device. On the fluoroscope monitor, the specialist is able to view the electrode (a hollow needle) in real-time as it is inserted into the targeted area.The patient remains awake and aware during the procedure to provide feedback to the physician, but will likely be administered a low-dose sedative for relaxation. The area is numbed before the procedure, and so the patient experiences pressure sensations, and very little pain.

Once the electrode is positioned correctly, it is heated and delivers a precise burn (lesion) to a small area of nerve. Radiofrequency ablation takes between 15-45 minutes to perform, and the patient is observed for a period of time before going home. Recovery time is typically one to three days, and pain relief is usually reported within two weeks after the procedure. Patients may experience pain for several days as a side effect of radiofrequency ablation (rhizotomy), but this can be treatment with pain relief medication. Uncommon side effects include infection, allergic reaction to the medications, localized numbness, and no pain relief.

For around 75% of all radiofrequency ablation (rhizotomy) patients, it is an effective means of pain relief that can last from 9 to 16 months, or longer. The nerve may regrow within a year, but the procedure can be repeated as needed.

CSC Spine Specialists can help diagnose and treat your facet joint pain. Schedule an appointment today.
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18601 LBJ Freeway, Ste. 618
Mesquite, Texas 75150
214-782-9222

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10 Medical Plaza Parkway Plaza III Ste 206
Dallas, Texas 75234
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1000 9th Avenue, Suite A
Fort Worth, Texas 76104
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Arlington, Texas 76012
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2700 W Pleasant Run Rd. Ste 210
West Enterance
Lancaster, Texas 75146
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