Low back pain is a very common and disabling medical condition. There are many potential sources of back pain including the intervertebral discs, muscles, ligaments and tendons. The most common source of back pain is the facet joint with is the source of movement in the spine. There is a pair of facet joints, one on each side of the pain at each level from the top of the neck to the bottom of the back. There are 24 pairs of facet joints in the spine. 7 in the neck, 12 in the thoracic spine and 5 in the lumbar spine. The most common sources of low back pain are the facet joints at the L4-5 and L5S1 levels which are the 2 lowest levels in the spine. These joints are the most likely to develop osteoarthritis because of the mechanical forces on the upright spine.
The facet joints have been recognized as the source of back pain for over 100 years. During the first world war a condition caused trench back afflicted soldiers in the tranches. Railroad spine is another term used for engineers who frequently developed back.
The term “facet syndrome” was first published by Dr. Ghormhley in 1933. He used the term to describe lumbosacral pain (low back pain) with or without sciatica.
Surgical treatment for facet joint pain, dates back to 1879 when Dr. Vincent Nesfield treated soldiers with trench back. In 1918 he used a fine, long scalpel to cut the nerves on either side of the spine At that time it was felt that the pain was due to a sensory nerve caught up in the muscle or fascia.
Dr. William Skyrme Rees learned the technique from Dr. Nesfield and performed the first procedure in 1960. He called the procedure “Multiple Bilateral Percutaneous Rhizolysis”which was very successful in treating chronic low back pain.
Dr, George Hacket, the father of prolotherapy performed the pro-lam procedure which involved the injection of 2.5 % phenol into the facet joint ligaments. To damage the nerves. 2 cases of paraplegia resulted from the procedure.
Dr. C Normal Shealy, and American Neurosurgeon, invented the TENS machine and spinal cord stimulation. He also developed the technique of radiofrequency ablation of the Gasserian ganglion for the treatment of trigeminal neuralgia. He modified this treatment for the radiofrequency coagulation of the articular nerve supply to the lumbar facet joints. This radiofrequency neurotomy (rhizotomy) was performed under fluoroscopic x-ray guidance was first published in 1973 and has become a common form of treatment for back pain since that time.
Dr. Nikolai Bogduk an anatomist from Australia dissected spines to identify the course of the medial branch nerves that innervate the lumbar facet joints and recommended modifications to the rhizotomy procedure to enhance the degree of damage to the nerve supply to the facet joints resulting in longer lasting pain relief.
Facet joint rhizotomy is the least invasive and most effective treatment of low back pain arising from the facet joints. 80 – 90 % of patients experience 1-2 years of relief of their back pain. The procedure is performed under local anesthetic with x-ray guidance. The risk of complications such as infection or damage to a nerve resulting in leg numbness or weakness is very low.
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