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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