The facet joints are often the primary source of pain for many back pain sufferers. Facet joints are small joints located in pairs on the back of the spine that provide stability to the spine and allow the spine to move and be flexible.


Depending on where the problematic facet joints are located, they can cause pain in the mid-back, ribs, chest (thoracic facet joints), lower back, abdomen, buttocks, groin, or legs (lumbar facet joints), neck, shoulders, and even headaches (cervical facet joints).

Facet joint injections of steroid medications are often given to patients with this type of pain. The injections not only provide pain relief, they can also help the physician pinpoint exactly where the pain originates and can confirm or reject the facet joints as the source of the pain. For many patients, facet joint injections provide adequate relief. For others, however, the pain relief is too short-lived. For these patients, facet rhizotomy may be the answer.

What is facet rhizotomy?
The goal of a facet rhizotomy is to provide pain relief by "shutting off" the pain signals that the joints send to the brain. The pain relief experienced by most patients who have this procedure lasts months or even years.

How it is done
Patients who are candidates for rhizotomy typically have undergone several facet joint injections to verify the source and exact location of their pain. Using a local anesthetic and x-ray guidance, a needle with an electrode at the tip is placed along side the small nerves to the facet joint. The electrode is then heated, with a technology called radiofrequency, to deaden these nerves that carry pain signals to the brain.

Serious complications with facet rhizotomies are rare. A new technique using pulsed radiofrequency does not actually burn the nerve, but appears to stun the nerve. This technique appears to be even safer than the regular radiofrequency technique, but does seem to have the drawback of not lasting quite as long. Some specialists (such as the author) prefer to use the pulsed technique in higher risk areas such as the neck.

The procedure takes about 30-60 minutes. Afterwards, patients are monitored for a short time before being released.

Kyphoplasty, a minimally invasive treatment for spine fractures caused by osteoporosis, is designed to provide rapid back pain relief and help straighten the spine.

STEP 1
Through a half-inch incision, small instruments are placed into the fractured vertebral body to create a working channel.

STEP 2
A balloon device is then placed into the fracture. The device is carefully inflated, creating a cavity inside the vertebral body.

STEP 3
The cavity is filled with bone cement to stabilize the fracture. Once filled, the instruments are removed and the incision closed.

AFTER THE PROCEDURE
With this process completed, an “internal cast” is in place that stabilizes the vertebral body and provides rapid mobility and pain relief. It restores vertebral body height, reducing spinal deformity.
Stabilized vertebra

Each vertebra in the spine is connected by two facet joints– one on each side of the spine.For back or neck pain believed to originate in these joints, a facetjoint block can be both diagnostic and therapeutic.  This injection can confirm whether the facet joints areindeed the source of pain and can help relieve the pain and inflammation. 

STEP 1

A small area of skin is numbed with a local anestheticinjection.

STEP 2

Guided by fluoroscopic x-ray, a needle is placed into thefacet joint.  The correct placementof the needle is confirmed by injecting contrast dye into the joint. 

STEP 3

A combination of a numbing anesthetic and ananti-inflammatory steroid medication is delivered to the joint through a thinneedle.  Depending on the locationof pain, one or more injections may be given.  If the pain subsides after the injection, this suggests thatthe facet joint(s) injected were the cause of pain.

END OF PROCEDURE

Back or neck pain may disappear immediately after a successfulblock.  However, once the numbingeffect of the anesthetic wears off, pain may return.  It usually takes 5 to 10 days for the steroid medication toreduce inflammation and alleviate pain.Effects may last several days or several months.  Up to three injections may be given peryear.  

This injection is administered to relieve pain in the neck,shoulders, and arms caused by pinched nerve(s) in the cervical spine.  Conditions such as herniated discs, spinalstenosis, or radiculopathy can compress nerves, causing inflammation andpain.  The medication injectedhelps decrease swelling of the affected nerve(s).  Some patients may need only one injection, but it usuallytakes two or three injections, given two weeks apart, to provide significantpain relief. 

STEP 1

This procedure is performed with the patient lyingdown.  Intravenous sedation may begiven, and an area of neck skin and tissues is numbed with a local anestheticdelivered through a small needle. 

STEP 2

Using x-ray guidance (fluoroscopy), the physician guides alarger needle to the painful area of the neck.  The needle is inserted into the epidural space, the regionthrough which spinal nerves travel.

STEP 3

Contrast dye is injected into the space to make sure theneedle is properly positioned near the area of the irritated nerve(s).

STEP 4

A combination of ananesthetic and cortisone steroid solution is injected into the epiduralspace.  The steroid is ananti-inflammatory medication that is absorbed by the inflamed nerves todecrease swelling and relieve pressure. 

This injection procedure is performed to relieve low backand radiating leg pain.  Thesteroid medication can reduce the swelling and inflammation caused by spinalconditions, such as spinal stenosis, radiculopathy, sciatica and herniateddiscs.  In some cases it may benecessary to repeat the procedure as many as three times to get the fullbenefit of the medication.  Howevermany patients get significant relief from only one or two injections.

POSITIONING THEPATIENT

In this procedure, the patient lays face down.  A cushion under the stomach areaprovides comfort and flexes the back.In this position the spine will open, allowing for easier access to theepidural space.  A fluoroscopeassists the physician in locating the appropriate lumbar vertebra and nerveroot. 

STEP 1

A local anesthetic numbs the skin and all the tissue, downto the surface of the lamina portion of the lumbar vertebra bone.

STEP 2

The physician then slides a thicker needle through theanesthetized track.  Aided by afluoroscope, the physician guides the needle toward the epidural space betweenthe L-4 and L-5 vertebral space.

STEP 3

A contrast solution is injected so the physician can use thefluoroscope to see the painful areas and to confirm the correct location of theneedle tip.

STEP 4

A steroid-anesthetics mix is injected into the foraminalepidural space, bathing the painful nerve root with soothing medication.

STEP 5

The needle is removed and a band-aid is used to cover thetiny needle surface wound.

This procedure is carried out to remove pain tin the lowerpart of the back as well as pain radiating down the leg.  Steroid medication reduces swelling andinflammation, caused by spinal channel narrowing, radiculopathy, sciatica andvertebral disk protrusion.  In somecases it is necessary to repeat the procedure up to three times to get amaximal effect from the medication; however, most of the patients get asubstantial pain relief after one or two injections.

During this procedure patient lies face down with a soft padunder the stomach for a better comfort and to help to relax the spine.  Such position of a spine gives an easyaccess to the epidural cavity.  Afluoroscope helps to find the specific lumbar vertebrae and nervous routs.  In the site of injection a localanesthetic is used first, which numbs all tissues up to the surface of thevertebra.  Using fluoroscope thedoctor introduces a thin bent needle in the foraminal space near nerveending.  Contrast substance helpsto verify the correct position of the needle.  Then into the foraminal epidural cavity a steroid-anestheticmixture is introduced, which soothes the painful nerve ending.  After the needle removal a smallband-aid covers the place of injection.

Possible side-effects are comparable with side-effects of asimple injection:  patient may haveallergic reactions, bacterial infection or bleeding, which occurs rarely.

Steroid side-effects:swelling of the face, arms and legs, diabetics may have their bloodsugar level raised.

It is obligatory to inform your physician about pregnancy orthe use of ‘blood thinning’ medications.