Facet Joint Denervation To Block Chronic Pain

Chronic low back pain is the most common pain syndrome in America. Many cases have a multifactorial cause. Radiofrequency denervation has been show to offer success with pain relief in many controlled trials and clinical studies. The diagnosis and treatment of facet joint syndrome can alleviate back pain for many patients.

Besides personal discomfort related to chronic pain, the persistent back discomfort associated with facet joint syndrome can restrict quality of life. In about 90% of people, back pain will disappear in 2-6 weeks. However, a large percentage of people suffer from persistent, chronic back pain secondary to facet joint degeneration and injury.

What causes facet joint pain?

The facet joint consists of two articular surfaces, and the joint’s synovial folds and capsule both contain nociceptive nerve endings. There are two facet joints per each vertebra, and each joint is supplied by a medial branch nerve that spurs from the spinal nerve. Facet joint pain occurs from segmental instability of the vertebrae. Degenerative disc disease affects the height of the intervertebral disc, and changes in the height puts more stress on each joint and capsule. Facet joint osteoarthritis affects 90% of people age 50 years and older. In a study of people with persistent low back pain, 31% of patients had facet joint arthritis and degenerative changes.

What is the purpose of facet joints?

Facet joints prevent excessive motion, toppling over, and over-twisting of the spine. The facet joints provide 20% of the spine’s stability in the neck and low back regions. In addition, the angle of facets is positioned to provide limits to motion, especially rotation and forward slipping of each vertebra over the one below it.

How is the facet joint denervation procedure done?

Denervation can occur using an ethanol injection, cryoablation, gamma knife surgery, or radiofrequency energy. After you are positioned on the procedure table, a nurse will disinfect the skin. With radiofrequency, using CT- or US-guidance (fluoroscopy), a procedure needle tip is placed in the facet joint. Mild electronic current is emitted onto the joint nerves. If ethanol is used, the surgeon injects the solution onto the nerves to destroy them. Regardless of what technique is used, the nerves are destroyed, which offers long-term pain relief.

Does facet joint denervation work?

In a recent study, 87% of patients showed pain improvement of 50% or more on a visual analogue scale after receiving facet joint denervation. Another study involving repeated radiofrequency denervation showed 92% success rates. Regarding facet joint radiofrequency denervation, most data comes from randomized controlled trials. At 24-months post-procedure, 66% of patients reported 80% pain relief in a recent clinical study.

Are there any precautions to take after facet joint denervation?

The entire denervation procedure takes around 50 minutes, and patients go home the same day. Because a sedative is used during the procedure, the patient needs to arrange for transportation home from the medical center. One the day of the procedure, patients must avoid doing strenuous activities and driving. In addition, patients can continue usual medications except for ibuprofen, aspirin, and blood-thinning agents.

Will I have pain after the facet joint denervation procedure?

The most common side effect of the denervation procedure is transient, sunburn-type pain. For most people, the pain is a mild ‘soreness,’ and it goes away within 12-24 hours. We recommend using an ice pack for 20-minute intervals several times each day. The nerves will eventually regenerate (grow back) after denervation, but some people report long-term pain relief.

Resources

Gofeld M, Jitendra J, &Faclier F (2007). Radiofrequency denervation of the lumbar zygapophyseal joints: 10-year prospective clinical audit. Pain Physician,10: 291-299.

Nath S, Nath CA,& Petterson K (2008). Percutaneous lumbar zygapophysial (facet) joint neurotomy using radiofrequency current, in the managment of chronic low back pain. A randomized double- blind trial. Spine, 33: 1291-1297.

Schofferman J &Kine G (2004). Effectiveness of repeated radiofrequency neurotomy for lumbar facet pain. Spine, 21: 2471-2473.

Van Kleef M, Barendse GAM, Kessels A et al. (1999). Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine, 24: 1937-1942.