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The facet joints are near the back of the individual bones of the spine called vertebra. The front of the vertebra are attached to the discs, which act as spacers and shock absorbers. In between, on both sides of the vertebra are openings through which spinal nerves exit the spinal canal. The facet joint is a true articulation where movement of adjacent vertebra occurs at the cartilage surface associated with joint fluid and a joint capsule. Pain from the facet joint itself usually involves the midline of the back as well as the muscles on both sides of the midline. Pain from the lumbar (low back) facets can refer pain out to the hips and upper leg. Pain from the cervical (neck) facets can cause daily headache or shoulder pain or pain between the scapulae (shoulder blades). A small nerve called the dorsal and medial nerve is a branch of the spinal nerve, and it transmits pain from the facet joint to the spinal cord. Each facet nerve transmits pain through two or three of these nerves. Medial branch radiofrequency ablation is a technique that makes use of a tiny heat source at the tip of a needle to quiet the pain transmitted by these minor nerves . Despite their small size, the medial branch nerves can transmit a lot of chronic back pain. The ablation is even less invasive than minimally invasive surgery. After discussion of the pain pattern, an examination and review of relevant x-rays and medical records, Dr. Ford will make a recommendation for testing to determine where the pain is coming from. Most doctors and patients don’t realize that MRI and other expensive imaging studies do not show pain. These are just detailed pictures of our bodies. In fact, when patients have spinal arthritis, so many structures can be reported as abnormal on an MRI, that it only serves to confuse the diagnosis. The way to tell if a part of the body is painful is to block the pain impulses coming from that part of the body, and see if the pain disappears. This is called a diagnostic injection. A diagnostic injection can be into a facet joint or the nerves that go to the facet joint. A diagnostic injection often involves more than one nerve branch at a time. This is because if even a single nerve branch is left behind to transmit pain from the back, it feels bad. When the patient and Dr. Ford are convinced that the right combination of nerves has been found to eliminate the pain, the next step is the decision to ablate the nerve. If the painful facet has been identified using a local anesthetic block into the joint, the addition of a steroid may provide weeks or months of pain relief. If only short term relief is obtained, then radiofrequency ablation is usually recommended to achieve 6-12 months of pain relief.
Is it painful? How long does the test injection pain relief last? How long does the RF ablation take? Is the ablation painful? Will I lose function with a nerve burning procedure? Why isn’t it permanent? How effective is the procedure? What happens when the pain returns? What are the risks? |
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