The lumbar facet joints are small joints located at the back of the spine. There is a pair at each level of the spine, which can undergo degenerative changes similar to knees, hips and shoulder joints. They are responsible for 30% of cases of back pain and the percentage increases with advancing age. Facet joint Osteoarthritis is similar to that which occurs in knees and hips. It involves damage to the cartilage, meniscal, ligaments and bone spur formation, which results in pain.

This illustration shows the facet joint cartilage is irregular with inflammatory changes, which are typical of osteoarthritis and mechanical back pain.

Unlike knees and hips there are no operations to replace the facet joints and they are too small to undergo arthroscopic repair. Intra-articular cortisone injections can provide pain relief but often last for a short period of time.

Facet joint pain can be relieved by a minor surgical procedure called facet joint rhizotomies or radiofrequency neurotomy, which is a procedure that involves inserting a needle onto the nerve that carry the pain signals from the joints. An electric current is applied that cauterizes the nerve.

This picture shows the needle and electrode in position on the medial branch nerve to the facet joint. Passing the electric current damages the nerve so that it no longer transmits the pain signal to the spinal cord and on to the brain.

Facet joint rhizotomy is a minimally invasive procedure that is performed under local anesthetic and x-ray guidance. A needle is inserted into the back and directed onto the medial branch nerves that supply the joint. Local anesthetic is injected onto the nerve so that the person does not experience pain during the procedure. An electrode is inserted into the needle and an electric current is applied which heats the tissue around the needle and cauterizes the nerve creating damage that prevents the pain signal from getting to the spinal cord and brain. Facet joint rhizotomies have a 70 to 80 % success rate in reducing or eliminating back pain. This usually lasts for a year or more. The nerves can regenerate and pain can recur. If this happens the procedure can be repeated.

Potential complications include infection and nerve root injury, which could cause numbness or weakness in a leg. However this is very uncommon. People usually experience pain from the procedure that can last for a few days. After that there pain is significantly improved or completely alleviated. Most people are able to reduce their pain medication and return to normal activity.

Facet joint pain is diagnosed by injecting local anesthetic onto the medial branch nerves under x-ray guidance. When the nerves to the painful joint are anesthetized the pain is immediately relieved. Once the painful joints have been identified then a rhizotomy can be performed to provide long-term pain relief. Facet joint blocks and rhizotomies can be performed at the Welcome Back Centre. For more information or to book and appointment for consultation with a pain specialist call 250-828-6740.