Cervical/Thoracic/Lumbar Facet Arthropathy

Cervical Facet Arthropathy»
Thoracic Facet Arthropathy»
Lumbar Facet Arthropathy»

Cervical Facet Arthropathy

Cervical facet arthropathy is neck pain that arises from the cervical facet joints located in the back of the neck.  Multiple studies have shown the evidence that the facet joints are capable of producing pain. Cervical facet joint pain is very common, and is the single most common cause for chronic neck pain after whiplash. Whiplash is the result of a forceful flexion and extension injury typically from a motor vehicle accident, but other causes such as trauma or certain sports can also contribute to this pain. It is said that whiplash affects over one million people each year and the prevalence of associated cervical facet pain has been estimated to be as high as 88% in patients who are involved in high speed accidents. The pain may or may not be apparent initially after the injury; it is possible to be delayed months or years. It is important to have a thorough physical exam by a specialists who is trained these disorders to identify which cervical facet joints are the source of the pain.

What are the options for treatment?

There are many excellent treatment options that can achieve long-term relief. Conservative treatments include anti-inflammatory medications as needed, postural correction stretching the shortened muscles and strengthening the opposing supportive muscles can be helpful. In recent studies yoga has also been found to be beneficial.  Other options if medically appropriate include manipulation by a Doctor Osteopathic Medicine or Chiropractor, while others find benefit from acupuncture.

If conservative options no longer provide adequate relief, there are minimally invasive procedures that can help you achieve long term relief. In a double-blind, placebo-controlled study, it was established that 70% of patients who obtained relief from medial branch blocks could obtain complete relief of pain if treated with radiofrequency ablation.  This study also showed unequivocally the results of cervical medial branch radiofrequency ablation were not a placebo.

Radiofrequency Ablation is the treatment of choice for many painful areas of spine whether it is a result of arthritis or a painful nerve. In the case of arthritis pain, the nerve (medial branch) that provides the painful sensation to the facet joints is interrupted.  Radiofrequency can offer more long term relief of the cervical, thoracic or lumbar region or other peripheral nerves.

What is radiofrequency? Radiofrequency is a safe, minimally invasive procedure using specialized equipment, insulated needle with a probe to deliver high-frequency, low voltage radio waves converted to heat that interrupts and eliminates the sensation of the pain form its source. There are different methods to deliver this electric energy, whether by pulsed (cooled) or heat (continuous) modes. Continuous radiofrequency interrupts the painful stimuli. In pulsed radiofrequency the nerve is pulsed to eliminate only the painful aspect while the function of nerve is maintained.

How is radiofrequency preformed? The procedure is performed in an operating room, with fluoroscopy (x-ray) using a specialized radiofrequency machine and equipment.  .  The needle is positioned using bony landmarks that identify the nerve location with fluoroscopy (x-ray). The needle is precisely placed within 1mm of the nerve to create an effective lesion. Therefore pinpoint accuracy is important in achieving the best results. Depending on the area treated the procedure may take 30-45 minutes.

Is radiofrequency painful?  Patients typically tolerate the procedure very well. The procedure involves inserting a needle through skin and those layers of muscle and soft tissues, so there is some discomfort involved. Conscious sedation is offered to allow more comfort during the procedure as well as local anesthetic to numb the skin and deeper tissues to provide comfort during the needle placement and during the radiofrequency portion of the procedure.

How long does radiofrequency last? The result with radiofrequency may vary depending on the severity of arthritis, progression of arthritis between intervals, and lifestyle choices.  Results are also dependent of accurate diagnosis made with nerve blocks that would indicate concordant pain relief and accuracy and precision of preforming the radiofrequency procedure itself. Typically we expect an average of 12 months however this can be as short as 6-9 months or as long as 18+ months

Is radiofrequency safe? Radiofrequency is a standard pain management technique that has been used for over 50 years in various regions of the body. Radiofrequency has full FDA clearance. However there are some insurance companies the claim it is “experimental” and not covered despite efforts to provide documentation with multiple peer review literature studies and text book chapters they still find it “experimental.”

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Thoracic Facet Arthropathy

The thoracic spine is mid-section of the spine and is located between the cervical (neck) and lumbar (lower back) region. There are twelve paired thoracic facet joints. Thoracic facet joint pain if often described as a constant aching pain that refers locally to the region along the thoracic spine.  It is commonly associated with scoliosis, vertebral compression fractures, trauma or the natural aging process. There are many excellent treatment options that can achieve long-term relief. Conservative treatments include anti-inflammatory medications as needed, postural correction stretching the shortened muscles and strengthening the opposing supportive muscle. Yoga has also been found to be beneficial.  Other options if medically appropriate include manipulation by a Doctor Osteopathic Medicine or Chiropractic, while others find benefit from acupuncture.

If conservative options no longer provide adequate relief, there are minimally invasive procedures that can help you achieve long term relief. Radiofrequency Ablation is the treatment of choice for many painful areas of spine whether it is a result of arthritis or a painful nerve. In the case of arthritis pain, the nerve (medial branch) that provides painful sensation to the facet joints is interrupted.  Radiofrequency can offer more long term relief of the cervical, thoracic or lumbar region or other peripheral nerves.

What is radiofrequency? Radiofrequency is a safe, minimally invasive procedure using specialized equipment, insulated needle with a probe to deliver high-frequency, low voltage radio waves converted to heat that interrupts and eliminates the sensation of the pain form its source. There are different methods to deliver this electric energy, whether by pulsed (cooled) or heat (continuous) modes. Continuous radiofrequency interrupts the painful stimuli. In pulsed radiofrequency the nerve is pulsed to eliminate only the painful aspect while the function of nerve is maintained.

How is radiofrequency preformed? The procedure is performed in an operating room, with fluoroscopy (x-ray) using a specialized radiofrequency machine and equipment.  The needle is positioned using bony landmarks that identify the nerve location with fluoroscopy (x-ray). The needle is precisely placed within 1mm of the nerve to create an effective lesion. Therefore pinpoint accuracy is important in achieving the best results. Depending on the area treated the procedure may take 30-45 minutes.

Is radiofrequency painful?  Patients typically tolerate the procedure very well. The procedure involves inserting a needle through skin and those layers of muscle and soft tissues, so there is some discomfort involved. Conscious sedation is offered to allow more comfort during the procedure as well as local anesthetic to numb the skin and deeper tissues to provide comfort during the needle placement and during the radiofrequency portion of the procedure.

How long does radiofrequency last? The result with radiofrequency may vary depending on the severity of arthritis, progression of arthritis between intervals, and lifestyle choices.  Results are also dependent of accurate diagnosis made with nerve blocks that would indicate concordant pain relief and accuracy and precision of preforming the radiofrequency procedure itself. Typically we expect an average of 12 months however this can be as short as 6-9 months or as long as 18+ months

Is radiofrequency safe? Radiofrequency is a standard pain management technique that has been used for over 50 years in various regions of the body. Radiofrequency has full FDA clearance. However there are some insurance companies the claim it is “experimental” and not covered despite efforts to provide documentation with multiple peer review literature studies and text book chapters they still find it “experimental.”

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Lumbar Facet Arthropathy

Lumbar refers to the area of the lower back between the lowest ribs and the pelvis (L1-L5). The facet joints are formed from paired joints as result of two vertebral bodies as they stack upon each other to form a joint. These joints help protect the spine by giving it stability to limit it from excess motion. There are specific nerves called medial branches that carry sensation to each joint. There are many causes that may contribute to facet joint pain. Most commonly facet arthropathy is a result of degenerative changes or arthritis called spondylosis.

There are many publications that describe the complexities of facet pain. To mention a few, Schwarzer et al showed that in younger aged, injured worker with chronic back pain, the prevalence was about 15%. The prevalence in older, non-injured, patients was 40%. This was also verified by Manchikanti et al in 2001 showed facet joint pain to be the most common cause for chronic low back pain with a prevalence of 40% in a heterogeneous group of patients. While there are clinical indicators that point to facet joint pain, there are no clinical features that allow a physician to accurately predict that pain in a patient with back pain arises from the facet joint (Manchikanti et al. The inability of the clinical picture to characterize pain from facet joints. Pain Physician 2000; 3: 158-166).

What treatments are available?

Conservative treatments include health lifestyle choices with food and exercise, smoking cessation, weight loss, anti-inflammatory medications as needed, postural correction stretching the shortened muscles and strengthening the opposing supportive muscles can be helpful. In recent studies yoga has also been found to be beneficial, particularly for neck pain.  Other options if medically appropriate include manipulation by a Doctor Osteopathic Medicine or Chiropractic, while others find benefit from acupuncture. Facet arthropathy evidence is noted extensively in literature, the only accurate method of diagnosing the condition is positive response to a Medial Branch Block (Dreyfuss P et al. Specificity of lumbar medial branch and L5 dorsal ramus blocks; a computed tomographic study. Spine 1997; 22:895-902). Although clinical features cannot be used to accurately diagnose the condition, there are certain clinical features that increase the likelihood of facet joint pain being positive. When these features are present and once the patient has failed attempts at conservative management the recommended treatment is a diagnostic Medial Branch Block. If the results of the block provides significant relief, Radiofrequency Ablation can then provide long term relief. Most insurance companies will cover this treatment at least once a year.

Radiofrequency Ablation is the treatment of choice for many painful areas of spine whether it is a result of arthritis or a painful nerve. In the case of arthritis pain, the nerve (medial branch) that provides a painful sensation to the facet joints is interrupted.  Radiofrequency can offer more long term relief of the cervical, thoracic or lumbar region or other peripheral nerves.

What is radiofrequency? Radiofrequency is a safe, minimally invasive procedure using specialized equipment, insulated needle with a probe to deliver high-frequency, low voltage radio waves converted to heat that interrupts and eliminates the sensation of the pain form its source. There are different methods to deliver this electric energy, whether by pulsed (cooled) or heat (continuous) modes. Continuous radiofrequency interrupts the painful stimuli. In pulsed radiofrequency the nerve is pulsed to eliminate only the painful aspect while the function of nerve is maintained.

How is radiofrequency preformed? The procedure is performed in an operating room, with fluoroscopy (x-ray) using a specialized radiofrequency machine and equipment.  .  The needle is positioned using bony landmarks that identify the nerve location with fluoroscopy (x-ray). The needle is precisely placed within 1mm of the nerve to create an effective lesion. Therefore pinpoint accuracy is important in achieving the best results. Depending on the area treated the procedure may take 30-45 minutes.

Is radiofrequency painful?  Patients typically tolerate the procedure very well. The procedure involves inserting a needle through skin and those layers of muscle and soft tissues, so there is some discomfort involved. Conscious sedation is offered to allow more comfort during the procedure as well as local anesthetic to numb the skin and deeper tissues to provide comfort during the needle placement and during the radiofrequency portion of the procedure.

How long does radiofrequency last? The result with radiofrequency may vary depending on the severity of arthritis, progression of arthritis between intervals, and lifestyle choices.  Results are also dependent of accurate diagnosis made with nerve blocks that would indicate concordant pain relief and accuracy and precision of preforming the radiofrequency procedure itself. Typically we expect an average of 12 months however this can be as short as 6-9 months or as long as 18+ months

Is radiofrequency safe? Radiofrequency is a standard pain management technique that has been used for over 50 years in various regions of the body. Radiofrequency has full FDA clearance. However there are some insurance companies the claim it is “experimental” and not covered despite efforts to provide documentation with multiple peer review literature studies and text book chapters they still find it “experimental.”

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