The facet joints are two small joints in the back of the spine, on the left and right sides, at each level. These joints work with the discs to provide support and motion to the spine.
There are several ways in which these joints can produce pain:
- Nerves in the joints can be compressed and/or irritated by inflammatory agents
- Facet joints can degenerate, become arthritic, and produce pain by forming osteophytes (bone spurs) which compress nerves passing into the legs.
As with many joints, degenerative changes can occur in the facets, which can become painful. Degeneration is likely to occur in the spine as a part of the aging process, regardless if surgery has been performed or not. However, some types of spine surgery may alter load or movement patterns of the spine, which in turn can affect the facet joints.
Causes of postoperative facet joint pain
Facet joints may be related to pain after spine surgery in several ways:
- These joints may continue to degenerate after a surgical procedure to treat a herniated disc or compressed nerve roots at the same spinal level
- Surgery may change the loading or movement patterns of these joints, leading to degeneration and pain.
Following a spine fusion at one spinal level, motion of the level(s) next to it may be altered to compensate for changes the fusion caused. This change in motion pattern may cause facets at the adjacent segment(s) to degenerate and become painful.
Facet joint pain is difficult to identify without injections into these joints. In back pain patients, pain may arise from more than one source within the spine. While surgery may address one problem, existing facet joint pain may not have been recognized prior to the spine surgery, and therefore not addressed.
Treatment options for facet joint pain
Treatment of facet joint pain may include one or a combination of the following:
- Physical therapy
- Chiropractic care/manual manipulation
If these treatments do not provide relief, then more invasive procedures are an option, including:
- An anesthetic agent may be injected into the joint in a facet joint injection
- If the injection provides short-term relief, then a facet rhizotomy may be performed to cauterize small nerves in the joint
- If facet degeneration causes nerve root compression, tissue may be removed during a surgical decompression
- If the spine is unstable or pain persists, spine fusion surgery may be considered.
The most important aspect of pre-operative planning for facet joint pain is the diagnosis. As with real estate investments, where the focus is on "Location, Location, Location," for spine surgery the name of the game is "Diagnosis, Diagnosis, Diagnosis."
It is therefore stressed that before any spinal surgical intervention is considered, a thorough diagnostic work up is needed to determine any and ALL causes of the back pain one is addressing.
This is part of the reason that a pre-operative discussion and a patient education program is necessary. This process will afford the patient a full understanding as to what is known and unknown in each individual case and what expectations can be set in accordance with all treatment variables.
Guest blog contributed by:
Stephen Hochschuler, MD
Spine-health Medical Advisor and Orthopedic Surgeon
Texas Back Institute