At Pacific Pain & Wellness Group in Los Angeles, we specialize in facet joint injections to help reduce pain and swelling caused by trauma, injury, or joint degeneration. Facet joint injections reduce inflammation, which relieves pain and allows your body to heal.
This treatment can make you more comfortable for a period of time so you can get back to doing what you love. With less pain, you can enjoy a better quality of life.
Facet Joint Locations In The Back & Neck
Your facet joints are located along the spinal column, which consists of 24 vertebrae. These joints allow your spine to move, twist, flex, extend, and bend comfortably without friction between the bones.
The spine is divided into several zones with facet joints in the following areas:
- Seven cervical vertebrae in the neck
- Twelve thoracic vertebrae in the upper & middle back
- Five lumbar vertebrae in the lower back
Each vertebral bone has a solid, structural area in the front (anterior spine) portion, an arch just behind the spinal cord, and a bony protrusion in the back (posterior spine). The center of the spine has a large circular opening that allows your spinal cord to pass through.
Your facet joint is located underneath each bony protrusion in the arch of the bone. Inside of each facet joint is a bundle of nerves that extend from either side of the spine to the arms, legs, and other areas of the body.
The surfaces of the facet joints are covered by a thin layer of cartilage, or padding, and are surrounded by a connective tissue joint capsule. Inside of this capsule is a mucous membrane called the synovial membrane that lines each facet joint. This important structure lubricates the joint and supplies the cartilage with nutrients.
Facet joints allow your neck and back to move comfortably. They also house and protect important nerve roots that leave the spinal cord. When your facet joints are healthy, they are coated with plenty of cartilage, which allows the bones to glide smoothly against one another. All of these protections allow for stability of the spine as well as proper nerve conduction.
Facet Joints And Movement
Facet joints allow movement in different ways depending on the area of the spine where they are located.
These movements include:
- Lateral flexion: bending of the body or the neck toward the right or left side
- Anterior flexion: bending forward of the neck or body
- Extension: posterior-directed motion such as straightening from a flexed position or bending backward
- Rotation: twisting motion
Cervical region: The facet joints in the cervical region are positioned at a 45-degree angle to allow for all types of movement in the neck including anterior and lateral flexion, extension, and rotation.
Thoracic region: The facet joints in the thoracic spine are positioned at a 60-degree angle. This allows for lateral flexion and rotation only.
Lumbar region: The facet joints in the lumbar region are at a 90-degree angle so they only allow for anterior flexion and extension. Some facet joints in the lower lumbar region are positioned to keep the vertebral column from sliding forward on the sacrum, which is the base of the spine.
Facet Joint Syndrome
Steroid injections can help relieve pain caused by facet joint syndrome. The most common cause of this condition is degeneration of the spine, also referred to as spondylosis. Degeneration is usually due to normal wear and tear of the joints as we age, poor body mechanics, or a combination of the two.
When joint degeneration is not directly caused by natural wear and tear, the condition is known as osteoarthritis.
Spondylosis, Spinal Stenosis, And Osteoarthritis
Spondylosis: Literally translated, spondylosis means that the patient is suffering from both facet joint degeneration and pain. This degenerative process affects the vertebral discs and facet joints caused by aging of the body.
A common form of spondylosis is cervical spondylosis where the facet joints in the neck become enlarged, causing ligaments around the spinal canal to thicken and develop bone spurs. This can narrow the spinal canal, resulting in compression of the spinal cord and nerve roots.
Compression can lead to spinal cord damage, causing symptoms such as:
- Impaired ability to walk
- Weakness and numbness in upper extremities
- Arm pain from a pinched nerve that radiates into one or both arms
Stenosis: Spinal stenosis, or an abnormal narrowing of the spinal canal, can cause pain in facet joints, especially when a person is walking. Facet joint pain can also be caused by degenerative disc disease. This happens when a disc becomes dehydrated and partially loses its ability to function. The degenerated disc can cause lower back or neck pain and, in some cases, leg or arm pain as well.
Osteoarthritis: This condition is a degenerative disease that leads to the breakdown of cartilage between joints. When the joints move, this lack of cartilage causes pain, loss of motion, and stiffness. Pain can occur during extensive activity, or conversely, during long periods of inactivity.
Osteoarthritis comes from the Greek words “osteo” (bone), “arthro” (joint), and “itis” (inflammation). Because facet joints are the only joints in the back, spinal osteoarthritis technically refers to inflammation in the facet joints of the vertebrae.
Facet joint osteoarthritis is usually caused by internal damage to the smooth cartilage of the facet joints. The joint then becomes painful, as described below.
- Cartilage on one side of the facet joint becomes damaged. Whenever the spine moves, the damaged cartilage rubs against its partner causing friction and more damage to each side.
- Joint friction leads to inflammation inside of the joint.
- The swollen joint transmits pain signals through the medial branch nerve that runs through the facet joint.
- This pain signal can put the back muscles into spasm.
- The combination of muscle spasm and inflammation of the facet joint results in severe lower back pain.
The spinal facet joints in the lower lumbar spine (lower back) are particularly susceptible to developing osteoarthritis. These joints are small in comparison to the weight that they bear. This disparity can result in stress and tension in the area, making the joints more vulnerable to cartilage damage and injury. An accumulation of stress and/or injuries over time can cause these joints to break down and degenerate.
Spinal Stenosis
Spinal stenosis occurs when one or more bony openings within the spine start to narrow, leaving less space where the nerves pass through. This can happen within the spinal canal itself or in the areas where the nerves exit the spinal canal.
Depending upon the location and the degree of narrowing over time, either a spinal nerve or the spinal cord itself could become compressed. This causes pain, tingling, numbness, and weakness. Spinal stenosis severity and symptoms can vary greatly from person to person.
- Pain or tingling. This may be dull and located either solely in the neck or lower back or it could be a sharp pain that radiates into the arms and/or legs. The sensation may also manifest as more of a tingling feeling than actual pain.
- Numbness. A reduction in sensation to include total numbness can be experienced in the arm, leg and/or other regions of the body.
- Weakness. Reduced strength or problems with coordination in the arm, leg and/or other body parts.
Diagnosis Of Facet Joint Syndrome
A diagnosis of facet joint syndrome is made through a combination of medical and diagnostic tests. A physical evaluation by a doctor is the first step. Your comprehensive evaluation will include multiple elements.
Patient History
Your doctor will discuss your complaints and symptoms. They will document when the onset of pain occurred, how long it usually lasts, what brings it on, the types of symptoms you are experiencing, any medical conditions you have, treatments you’ve tried, and surgeries you’ve had.
Medical Examination
Your physician may gently tap on your lower back and lumbar vertebrae to check for:
- Tender spots along the lumbar spine (bone and soft tissue)
- Muscle reflex action in the legs to assess nerve function and conduction
Your exam may also include:
- Hands-on inspection to detect muscle spasm
- Visual inspection of your general posture and the skin in the affected area(s)
- Range of motion tests to determine mobility and alignment of the joints
- Sequential exam to check each segment of the spine for proper mobility
- Neurological exam including tests of muscle strength, skin sensation, and reflexes
If a diagnosis of facet joint syndrome is suspected, standard treatment options will be tried first. This usually means pain medication, physical therapy, and spinal manipulation. Generally, diagnostic imaging and/or injection tests are not required to treat and resolve a single painful episode. If the first line of treatments does not resolve your issue, imaging and injections may be recommended.
Tests To Diagnose Facet Joint Pain
Radiographs, MRI, computed tomography (CT) scans and other more specialized tests may be used to diagnose pain in the facet joints and nearby structures.
- Radiography might show bony changes and bone spurs within a facet joint. Front-to-back, side views, and off-angle images can provide a 360-degree view of your spine.
- MRI scans can be used to assess the spine and its soft tissues such as discs and nerve roots. The scans may also be useful in distinguishing a chronic condition from an acute one. In someone who has had spinal surgery, MRIs may be performed following an injection of a contrast dye to get a better view of blood flow to the region.
- CT scans are useful for looking at bones.
- SPECT scans are used with a bone scan or CT scan when viewing the intricate bones of the spine. This allows the radiologist to see finer details. Such tests also help either identify or rule out tumors and cysts in the lumbar spine.
Diagnostic facet joint block injections: Diagnostic facet joint blocks involve injecting cortisone medication (to reduce swelling) and an anesthetic (to numb) into a particular nerve root. Like diagnostic nerve blocks, this type of facet joint injection is done to see where your pain may be coming from.
If the injection relieves your pain at that site, then that will confirm which facet joint needs attention. If the injection offers no relief, your doctor will inject another facet joint until the precise area of pain is located.
Treatments For Facet Joint Syndrome
Non-surgical options are usually the first line of treatment. This approach generally has a high rate of success because many options are available. It is typical to use several treatments at one time to achieve optimal relief.
First line treatments:
- Physical therapy
- Heat therapy or cold packs
- Non-steroidal anti-inflammatory medication
- Using a lumbar support brace
- Avoiding activities that worsen pain
- Engaging in low-impact exercises
- Supporting the lumbar curve when sitting
- Opioid pain medication (only when absolutely necessary)
Surgery may be recommended if any of the following are present:
- Involvement of the spinal cord
- Pain and dysfunction that fails to respond to non-surgical treatments
- Severe conditions such as complex fractures or major dislocations
Physical therapy typically includes a combination of hands-on therapy, low-impact aerobics, strengthening exercises, and stretching. This combination is very effective in reducing facet joint pain for many people. Over time, physical therapy treatment improves and maintains the stability of the lower back and promotes healing in the tissues.
Medication can be helpful and usually includes over the counter options such as ibuprofen or aspirin. Prescriptions for muscle relaxers and stronger pain medications are also an option for more severe cases.
A facet joint injection can address neck and back pain along with the aforementioned non-surgical treatment options. Facet joint injections do not permanently relieve pain. Most people need one or more injections over a period of six months.
There are two types of injections that can be done.
- Facet joint injections – medication is directly injected into the joint
- Medial branch blocks – stops transmission of pain signals by targeting the nerves along the facet joint
How Facet Joint Injections Are Done
The doctor will use fluoroscopic (X-ray) guidance during your injection. This allows them to view your joint and guide the needle so that it is placed in the precise spot where it needs to go. A mixture of anesthetic (for pain) and cortisone (for swelling) will be injected directly into the facet joint to provide relief.
Treatments take approximately five to fifteen minutes. Anesthetic in the medication mixture provides you with temporary pain relief right away. The steroid medication reduces swelling in the days following treatment, which can result in extended pain relief.
Facet Joint Injections In Los Angeles – Pacific Pain & Wellness Group
If you have back or neck pain that is negatively affecting your quality of life, get in touch with one of our skilled doctors. Pacific Pain & Wellness Group in Los Angeles has an experienced team of pain management specialists who can successfully treat your pain using both innovative and standard treatment options.
At Pacific Pain & Wellness Group, we care about you as much as you do. Our goal is to help you feel better so you can live better.