Facet (Spine) Pain

Dr. John De Angelis, MD

Facets are small joints similar to finger joints. Facet joints are the “hinges” which join or connect each vertebra to the vertebra above and the one below. The facets hold your spine together (see picture). Facet joints are the second most common cause of spinal pain. The most common source of spinal pain is the spinal disc. Each joint has a nerve supply which can transmit or cause pain. The diagnosis of facet pain can only be made by blocking the nerve next to the facet joint. Local anesthetic is injected at the nerve site with a needle which is directed by an a special type of X-Ray machine. If the pain is dramatically reduced after the block, the injected joint is considered the cause of the pain in question.

The value of the test is determined by how much pain is gone after the nerves are numbed or blocked. Sedatives and pain medication decrease the pain and therefore, the test would be of no value. You must not take your pain medications on the day of the test. Sedatives will not be used during the procedure in that you must have your original pain or the test not be accurate.

Once there is enough evidence that the facet joints are the cause of your pain, radiofrequency denervation is scheduled. For this procedure an electronic needle is used to apply an electric current to the nerve or nerves which cause of the pain. The purpose of the electronic current is to cause the nerve to become inactive and insensitive to pain. When the eclectic currant is applied, sedation and pain medications are given intravenously in an effort to make the procedure as comfortable and safe as possible. The nerves will usually grow back in 5 to 12 months.

Following the procedure most patients have 60% to 100% reduction in pain. Some patients will not experience pain reduction. The pain reduction, when it occurs, typically last for 6 months to one year. The nerves will eventually grow back (regenerate), and the pain will most likely return. If the pain does return, a second procedure can be performed without the diagnostic testing. Similar results will usually be achieved with repeated procedures.

Prior to having this procedure performed, each patient will receive a much more extensive verbal and written explanation.

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