What is Lumbar Facet Joint Pain?
Lumbar facet joint pain is one of the most common of all persistent and disabling low back pain problems, and can cause significant low back pain and disability. The pain experienced in the lower back (lumbar spine) is usually localized to the area of the lumbar facet joints which lie between two or more vertebrae in the spine. Pain and inflammation occur when wear and tear of the facet joint in the lower spine causes the breakdown of cartilage. This causes the parts of the joints to rub together which results in stiffness, inflammation and pain.
What are the Causes of Lumbar Facet Pain?
Pain that radiates from the lower back is generally due to the breakdown of cartilage caused by:
- Constant stress to the spine
- Repetitive or high impact injuries
- Diseases, and
All of these conditions can cause pain, degeneration, the loss of function and have an impact on the quality of life.
The spine consists of 33 vertebrae, the upper 24 spinal bones called articulating and separated by intervertebral discs while the lower 9 are fused. The bones of the spinal column protect the spinal cord which passes through the back portion of the spinal column. The spinal segment of the lumbar spine (L1 to L5) consists of 5 bones and 2 facet joints which are located on are each side of the spine. There are two facet joints located between each vertebrae, which allow for the flexibility to bend forward, back and side to side.
Like other joints in your body the facet joints have cartilage that line the joint and capsule the surrounding joints. This lining allows the bone to glide smoothly over another when the body is in motion. The function of the facet joint is to provide support, stability, and mobility to the vertebrae (spine). Facet pain or disease occurs when there is degeneration of the facet joint, which causes the joints to rub together.
Diagnosis of Lumbar Pain
The diagnosis of lumbar facet joint pain is made by a physical examination, which includes a complete history of the pain and a discussion on what causes or alleviates pain and a X-ray, or MRI.
A diagnostic nerve injection into the facet joint or nerves near the joints can often confirm the facet joints as the source of pain.
Minimally Invasive Treatments Include:
Those who suffer from acute back pain that is not controlled by physical therapy, the use of heat or cold therapy, or medications such as nonsteroidal anti-inflammatory drugs (NAISD) and opiates may be candidates for surgery.
Non-surgical options may include:
- Facet Injections which combine a local anesthetic and a corticosteroid anti-inflammatory medication.
Radio Frequency Ablation uses radio waves (or an electric current) to generate heat that is used to interrupt nerve conduction.
- Medial Branch Blocks combines combine a local anesthetic and a corticosteroid anti-inflammatory medication which is injected into the nerves under guided imagery.
What are the Typical Results?
- Facet joint injections can last from several days to a few months and most procedures are deemed successful. This procedure can be used therapeutically and diagnostically to confirm the diagnosis.
- Radio Frequency Ablation can provide pain relief from 9 months to 18 months or longer and improvement is typically seen within 2 weeks. This procedure can provide sustained relief and may only require one or two procedures.
- Medial branch blocks can provides rapid results after treatment. The goal of a medial branch nerve block is diagnostic, not therapeutic, so patients should expect their original pain to return after anesthetic wears off.