Osteoarthritis is the most common type of arthritis affecting the spine. It affects the facet joints in the neck and back leading to pain and stiffness. It is due to degeneration caused by wear and tear. Back and neck injuries, such as whiplash, can contribute to the development of osteoarthritis in the spine. Damage to the cartilage results in pain that is often aggravated by bending and twisting. People often experience brief knife-like jabs of pain followed by intense muscle tension. The pain can last for a split second or can last for days or weeks. Attacks of pain often become more frequent and last longer as the osteoarthritis becomes more advanced with age. It is most common cause of disability from work and prevents people from enjoying activities such as gardening, golfing, playing pickle ball or even doing regular household chores.
CT and MRI scans of the spine will reveal facet joint degeneration but do not necessarily identify the origin of back or neck pain. They are most accurate at identifying pinched nerves that cause arm or leg pain.
Each facet joint in the spine is supplied by 2 medial branch nerves that sends pain signals to the brain. Identifying which joints are the source of the neck or back pain can be achieved by performing medial branch blocks. Local anesthetic is injected onto the nerves under x-ray guidance. They should be performed while the person is in pain. If the correct nerves are frozen the pain is immediately gone. Back or neck pain may be due to arthritis in 1 joint or in multiple joints. This can be determined by injecting local anesthetic (medial branch blocks).
One the source of the pain is identified it can be treated. Cortisone injections into the painful joints can sometimes give pain relief for days, weeks or sometimes months. Radiofrequency neurotomy, also called a rhizotomy, damages the medial branch nerves which prevents pain signals from reaching the brain. A rhizotomy procedure relieves the neck or back pain for 1-2 years or longer in 80 – 90 % of cases. The medial branch nerve do regenerate and the pain will recur because the osteoarthritis does not go away. When pain recurs the rhizotomy can be repeated.
If the pain is gone people can return to normal activity with little or no risk of causing more damage to their spine because they do not feel the pain.
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