Facet Rhizotomy for the Treatment of Chronic Back and Neck Pain
INDUSTRY INSIGHT
PAIN MANAGEMENT SPONSORED CONTENT
The etiology of spinal pain is often multifactorial. Causes of pain include muscular( strains to the muscles, tendon, ligaments), discal( injury or degeneration of the spinal discs), or skeletal( trauma or degeneration of the bony structures of the spine).
What are facet joints?
The facet joints are one skeletal structure that can cause neck or lower back pain. Facet joints are true synovial joints that connect spinal vertebrae to each other. The function of these joints is to provide stability and motion to the spine, especially in flexion and rotation. Due to the mechanical nature of their function, like all joints, they will undergo degenerative changes with age and cause pain. Likewise, facet joints can also be injured from trauma or overuse.
Symptoms of facet disease:
Common symptoms relating to facet pathology include diffuse pain or deep ache in the involved area. In the lower back, pain can radiate to the buttocks, and posterior thighs. In the neck, pain can radiate to
the top of the shoulders, shoulder blades, and can even cause occipital headaches.
Diagnosis:
Facet pain is typically diagnosed with patient’ s history, physical exam, or imaging studies such as X-rays, CT scan, MRI, and bone scan. Since imaging results can yield false positives or negatives, intra-articular facet injection and / or medial branch block is the gold standard of all diagnostic modalities.
Treatments:
Conservative treatment of facet arthritis includes physical therapy, chiropractic care, and medications such as anti-inflammatories, acetaminophen, and muscle relaxers. In more advanced cases, if conservative treatments fail, the facet joints can be injected. Injecting the joints with a corticosteroid and anesthetic can serve two purposes. First, it can be used as a diagnostic block to determine if the primary pain generator is indeed coming from the facets. Second, it can be used as a treatment to decrease inflammation and pain caused by facet arthritis. Successful diagnostic facet injection may indicate future benefit from facet rhizotomy for long-term pain control.
What is facet rhizotomy?
Facet rhizotomy is a procedure where a needle with an electrode at the tip is placed alongside the nerves( medial branches) that innervate the facet joint. These medial branches allow for the transmission of pain signals from the facet joints. The needles are then connected to a generator that delivers heat with a technology called radio frequency to deaden the medial branches. The pain relief from doing a rhizotomy may last from months to years.
This Industry Insight was written by Stephanie H. Le, MD.
Dr. Le is an interventional pain management specialist who helps treat the source of her patients’ pain using interventional spine injections and procedures, with the goal of returning them to the most functional lifestyle possible. Dr. Le is board certified in pain management and physical and rehabilitation medicine. She is a member of the International Spine Interventional Society, the American Society of Interventional Pain Physicians, and the American Medical Association.
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