Managing Facet Joint Spine Pain

Treating Joint Pain in the Neck and Spine

A car accident or slip-and-fall can result in severe pain in the neck and spine. “Whiplash” is a commonly used term for the tissue damage caused by a violent jerking of the head and spine during sudden impact.

After an accident there may be a diagnosis of soft-tissue damage to the spongy disks between the vertebrae to cause swelling, bulging and painful pressure on surrounding nerves. In extreme cases the damage can cause temporary or even permanent paralysis and loss of the use of arms and legs due to damage to the spinal cord nerves. With today’s newest CAT scan and MRI technology, the affected areas can be identified and treated with considerable success. Chiropractic manipulation, anti-inflammatory drug injections, pin-point laser surgery and other microsurgical techniques can bring much needed pain relief to victims of accidents.

Facet Joints in the Spine

The spinal column also has real joints (just like the knee, elbow, etc.) called facet joints. The facet joints link the vertebrae together and give them the flexibility to move against each other. The facets are the ’bony knobs“ that meet between each vertebra. To prevent excessive motion, over-twisting or toppling over, the segments of the spine are stabilized by a number of structures that nonetheless preserve the flexibility needed to turn, look around and get around.

The facet joints, or joints with “small faces” are found at every spinal level (except at the top level) and provide about 20% of the torsional (twisting) stability in the neck and low back. These bony knobs form the facet joints that connect the vertebrae together. There are two facet joints between each pair of vertebrae, one on each side. They extend and overlap each other to form a joint between the neighboring vertebra facet joints.

The facet joints give the spine its flexibility. The facet joints are synovial joints, structures that allow movement between two bones. The ends of the bones that make up a synovial joint are covered with articular cartilage, a slick spongy material that allows the bones to glide against one another without much friction. Synovial fluid inside the joint keeps the joint surfaces lubricated, like oil lubricates the parts of a machine. This fluid is contained inside the joint by the joint capsule, a watertight sac of soft tissue and ligaments that fully surrounds and encloses the joint.

Facet disease surgery may be an option for patients who are not responding to traditional facet disease treatment like analgesics, physical therapy, rest or osteopathic manipulations -- or for those patients whose facet joints have developed bone spurs (osteophytes). If your pain is limiting your ability to walk, work, play sports, or perform daily activities, it may be time for facet disease surgery.

Laser Surgery and Bone Fusion

More lasting relief of the facet joint problem can be obtained by destroying some of the tiny nerve endings serving the joints. This can be accomplished by a tip freezing or an electrified hot probe technique (also known as a facet rhizotomy) performed under careful x-ray control, (or for a lesser time by a carefully controlled injection of botox toxin which treats the muscle spasm).

There are several national locations, including Tampa, FL that offer a minimally invasive procedure. First, an IV sedation and local anesthetic is administered. Next, a surgeon makes a small incision and inserts a tube containing both irrigation and a laser. These tools clean the facet joint and then deaden its nerve, similar to a root canal. This surgery is an outpatient procedure that takes approximately 40 minutes, and the patient is typically free to go home after 1-2 hours of monitoring. A post-operative visit is scheduled with the patient for the following day.

In unusually severe and persistent problems, degeneration of the adjoining disc is nearly always present so the segment may require a bone fusion surgery to stop both the associated disc and facet joint problems. Such surgery may be considered radical, but an untreated persistent, episodic, severely disabling back pain problem can easily ruin the active life of a patient and surgery can therefore be a reasonable choice in selected cases.

Fortunately, for the vast majority of patients, a combination of change in life style, medication and proper exercise and posture will reduce the problem to a manageable level.

Non-Surgical Relief

To break up a cycle of recurring, acute facet joint pain, a number of treatments can be used successfully. Many of these treatments give some or even a lot of temporary relief but all too often, little long-term help. There are a number of nonsurgical treatment options that can be tried to alleviate the pain and rehabilitate the back, such as:

• Successful long-term treatment involves proper exercises, with instruction by a trained physical therapist or other healthcare provider.
• Good posture (maintaining a normal curvature of the spine such as pulling the car seat quite forward or when standing at a sink, putting one foot up on a ledge, bending that knee a bit), support to the low back when seated or riding in a car (particularly in the acute phase). A very useful posture when standing or sitting is the pelvic tilt - where one pinches together the buttocks and rotates forward the lower pelvis - and holding that position for several seconds, done several times per day.
• Heat (e.g. heat wraps, a hot water bottle, hot showers) or cold (e.g. cold pad applications) may help alleviate painful episodes.
• Changes in daily activities (e.g. shortening or eliminating a long daily commute), and adding frequent rest breaks
• The use of anti-inflammatory medication, such as various non-steroidal anti-inflammatories, called NSAIDs (e.g. ibuprofen) and the more recent Cox-2 inhibitors (e.g. Celebrex)
• Chiropractic manipulations or osteopathic manipulations may provide pain relief
• For the neck, a restraining collar may bring temporary relief, as may also cervical traction. A suitable supportive neck pillow is often essential. Abnormal nighttime flexion positioning of the neck, such as when using a pile of pillows, is to be avoided.

Call the Law Offices of Ron Sholes, P.A., if you have questions about insurance and emergency medical care and aftercare for personal injury and accident cases.