The facet joints are comprised of a bony piece of the vertebrae (facet) that articulates with a similar bony piece (facet) of an adjacent vertebrae. These two facets link the two vertebrae. The facets glide and slide over one another creating a joint. Any joint in the human body can become irritated and inflamed and cause pain. This is referred to as arthritis. Facet arthritis is often referred to as facet arthropathy or spondylosis. Each facet has a smooth surface that is made up of cartilage allowing the two facets to slide and glide over one another. Inflammation of the facet joint causes erosion of the cartilage. This leads to pain, stiffness and limited motion. When your facet joint experiences this it will begin to develop bone spurs. Bone spurs are being formed because you body is trying to fuse the facet joint so there won’t be any motion in the joint. The body is smart enough to know that if there is no motion through an arthritic facet joint then there will be no pain.
The spine has many areas where your pain may be originating from. The facet joints are one of these areas. Pain mapping is a technique that Dr. Valente uses to help identify the exact location of your pain. Injections can be done at a specific nerve or in a specific joint. If there is excellent pain relief from injection of one nerve or one joint and not the others then the source of the problem has been identified and treatment can be focused on that particular nerve, disc or joint.
When the source of pain has been localized to one or two facets treatments can range from a few days of rest with anti-inflammatories to facet injections with very minute amounts of local anesthetic or steroid. This can result in long lasting results. Additionally, an injection procedure referred to as a medial branch block can be performed where a small amount of anesthetic or steroid is placed around the small nerve that senses pain in the joint. If those injections work but wear off, some patients chose to have a procedure call a rhizotomy where heat or radio frequency is used to deaden the small nerves that sense pain in the joint. When all of these attempts at improving your back pain fail, the last option is a minimally invasive procedure to fuse the facet joint. This can be done via a 3 to 15 mm incision where a small bone dowel is carefully placed in the facet joint to help it fuse. This is done on an outpatient basis with a tiny suture-less incision.