Facet Syndrome is a situation that people who are a little older are going to get. It is a progressive disease that starts almost at zero and can account for 40% of low back pain complaints, certainly as we get into our 70s and 80s. The problem is a result of the facet joints. The facet joints are the guiding joints in the back of the spine. One of the issues that begins to occur as we get older is that the discs in the back lose their water content. As that happens, the facet joints, which were born on center get off center. As a result, we have three things that can happen to the facet joints at that point in time.
Why the Facet Joints Hurt?
The facet joints are actually lined with synovial tissue, which has a fairly good sensory nerve supply. In addition, the joint is covered by a capsule, and the capsule has a very sensitive nerve supply as well. These both act to restrain the motion of the back. So in addition to the nerve supply telling the brain where the back is in three-dimensional space, the bone acts as a bumper, so that it restricts our range of motion, like when you are swinging a golf club that you don’t just keep twisting around. As we previously discussed, when we age, we begin to lose the water content in the discs, causing the facet joints to move off center. When that occurs, bone-on-bone contact occurs – pinching the soft tissues, the synovial tissues in the joint, and stretching the capsular tissues. Additionally, osteophytes (a byproduct of arthritis) can also pinch the soft tissues, compounding the pain.
Activities that involve twisting (like golfing) can aggravate the pain. Leaning back and over-extending can also cause sharp pain.
Non-Surgery Treatments for Facet Syndrome Pain
Initially Facet Syndrome pain can be dealt with through rest. Anti-inflammatory medication will carry you for a few years. If symptoms persist, pain management can assist with injections of Novocaine and some cortisone. This helps treat the problem on a temporary basis – from months to up to a year. If that doesn’t work or it lasts on a temporary basis, the next treatment is usually radio-frequency. This is done with placement of RF or radio-frequency probe by the pain management doctors, down into the area of concern, near the nerve supply. The radio-frequency will block the nerves on a temporary basis. This procedure can block the pain for a period of a few months to a year, and then the pain starts to come back. If this sounds familiar, maybe you have sought out a more permanent kind of solution.
Fusion versus Endoscopic Facet Debridement
In seeking a more permanent solution to ending back pain, many patients are offered a fusion, which is a tremendously large operation with a long recovery period that only works two thirds of the time. It is a pretty dramatic type of a fix and can create more problems than the one the surgery is attempting to solve. Dr. Mork began to look at the problem in a different way a number of years ago. With the endoscope, and looking directly at the facet joint, he could see that the problem causing the pain was the pinching of the tissue. So with the laser, he began to remove the tissue from inside as well as a portion of the capsule that conducts the nerves in the cervical spine, thoracic spine, and lumbar spine. Over a period two years, 77% of his patients had at least a 50% reduction in their pain – a large improvement over fusion patients.