Pain Management and Surgery for Facet Joint Pain

Question: How to Treat Pain from a Slipped Facet Joint?

What are the options for treating facet joint that has slipped slightly forward at L-4 and L-5 (results of MRI)? I have tried Vioxx, and stretching and strengthening exercises for 3 months.

The pain continues, especially after golf or tennis or sitting, occasionally in buttocks and down left leg. I regularly have slight tingling in left foot, no known instance causing injury--seems to have developed from overuse--primarily golf. I am male, age 55.

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Doctor's Response: Epidural Injections and Spinal Fusion for Spondylolisthesis

This is most likely a degenerative spondylolisthesis. Besides medication and physical therapy, other choices to treat the spondylolisthesis would include epidural steroid injections or a one level spine fusion. Epidural injections are easier to go through, but the surgery is more reliable. Basically, if the joint has slipped, then the facet joint is degenerated and is no longer competent to stabilize the spine properly. A fusion surgery should stabilize the unstable painful joint. Where there is no motion, there shouldn't be any more pain.

Besides medications you may want to consider physical therapy and/or chiropractics. If this does not improve the pain, and it is limiting your normal level of functioning, you may want to consider epidural injections. If these do not work, a spinal fusion may be a reasonable option. Usually, surgery is only considered for patients with significant functional limitations.

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In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.

Written by Medical Reviewer