Almost everyone is familiar with the injury term “whiplash” as a result of spinal trauma. What, however, is a facet joint injury, and what are the common treatment methods to reduce or alleviate the pain?
The facet (zygapophyseal) joints are the articulations or connections between the vertebraes in the spine and occur in pairs at each vertebral level. The facet joints work with the corresponding disc to link the vertebrae directly above and below to form a working unit that lends stability and weight-bearing capacity while permitting flexibility and movement of the spine. The facet joints have a synovial lining, covered with hyaline cartilage. These joints contain nerves, the medial branches, that transmit pain back to the spinal cord. Injuries to the spine can inflame the facet joints, or cause the cartilaginous surfaces to wear away, causing back pain in the vicinity of the inflamed joint as the friction increases within the joint space. On occasion, the pain is located several inches away from the inflamed joint, or even into the limbs.
Treatment of facet injuries includes physical therapy, acupuncture, spinal manipulation, massage, heat and medications to reduce pain. Anesthetic and steroidal injections under fluoroscopic (x-ray) guidance are another common diagnostic tool that can provide very good therapeutic results in combating a facet joint injury. Immediate alleviation of pain following a facet injection confirms the pain source. If conservative treatment modalities provide only temporary relief, radiofrequency neurotomy can provide a longer lasting result. Under this procedure, a radiofrequency probe deadens the small nerves that supply the facet joint to reduce pain.
A less traditional modality which can have very good results, but not always covered by insurance plans, is prolotherapy. Prolotherapy involves repeated injections of a solution of concentrated dextrose (pharmaceutical-grade sugar water) and local anesthetic into the injured facet joint. Prolotherapy is thought to encourage the body to naturally produce connective tissues, collagen and cartilage, in the injured area to reduce pain by stimulating the immune system to bring fibroblasts and chondroblasts to the pain area and to rejuvenate it.