Facet Joint Syndrome Treatment

Facet Joint Syndrome Treatment

After facet joint syndrome is diagnosed through history, physical exam, and imaging studies, an appropriate treatment plan can be put into place. Usually treatment begins with conservative therapies including lifestyle modifications, alternative therapy, physical therapy, and medication.

Minimally invasive surgeries are performed through a small incision with minimal disruption of the surround muscle tissues, to allow for faster healing and return to normal activities. This is a much safer option to traditional spine surgery which required a large incision and cutting muscle tissues. There are several minimally invasive procedures available to address facet joint syndrome and the best option will vary by spinal region (i.e. cervical, thoracic, or lumbar section). Stabilization procedures, which prevent further joint movement, are generally preferred because the damage caused by facet joint syndrome is irreversible and continued motion would cause further damage.

Conservative Options

Lifestyle Modification

One of the main causes of facet joint syndrome is excess weight, which accelerates age related changes in the facet joints with added stress from trying to keep the spine in alignment. Weight loss through a low-calorie diet and/or exercise regimen can remove added stress on the facet joint. Even though the arthritic changes including loss of cartilage lining and bone spur formation is irreversible, the reduced weight can decrease pain and slow the progression.

Altering repetitive occupational and leisure activities may be necessary to accommodate the symptoms associated with facet joint syndrome. A change in jobs may be necessary to avoid worsening symptoms due to full labor or heavy-duty work. When changing jobs is not an option, working with equipment that may be an adjunct, proper lifting technique, use of a back brace, and proper rest breaks may all be necessary. Changing positions and avoiding extended periods of sitting may also be effective ways of reducing symptoms.

Alternative Therapy

Alternative therapies include massage, chiropractic care, and acupuncture. These may also be referred to as manual therapies as they address spine with hands on technique. Massage relieves tension in the muscles surrounding the spine caused by abnormalities in walking and by changes in posture due to pain from inflamed facet joints. Chiropractic care helps to adjust the spine through range of motion of the neck and specific stretches/movements of the neck. Acupuncture may also provide pain relief as muscles are stimulated electrically.

Physical Therapy/Exercise

Physical therapy focuses on changing body mechanics to improve posture and gait, as well as to strengthen and retrain muscles, particularly those in the core. The initial step is meeting with a Physical Therapist for a consultation to assess posture, gait, and muscle weakness and to design a personalized exercise program. Physical therapy may also use manual treatments, such as massage, ultrasound, and electro-stimulation through a TENS (transcutaneous electrical nerve stimulation) unit.

A home exercise program may be used in conjunction with or instead of formal physical therapy. A low impact exercise regimen can help strengthen the muscles, especially the core, which can support the spine to reduce back and neck pain from facet joint inflammation.  In order to prevent injuries, home exercise regimens are best done under physician supervision.

Medications

There are multiple types of prescribed and over the counter medications that may be used to treat the symptoms of facet joint syndrome. Some of these medications include Acetaminophen (Tylenol), NSAIDs (nonsteroidal anti-inflammatory drugs), muscle relaxants, and, topical medications.

Common over the counter medications are acetaminophen and NSAIDs. Acetaminophen is considered an analgesic, meaning it relieves pain but does not reduce inflammation. NSAIDs are effective at both relieving pain and reducing inflammation; they can be found in brand and generic forms over the counter. These medications are best taken with food to avoid an upset stomach. They can be taken for longer durations, as long as there is no history of kidney disease. The mechanism of both NSAIDs and Acetaminophen differ, so they are taken together often to combat pain.

Muscle relaxants are used to provide relief from muscle spasms and increase range of motion; they are best used in combination with physical therapy or an exercise/stretching regimen. Drowsiness is a common side effect of muscle relaxants and they are not recommended while driving or working. Common muscle relaxants include Flexeril, Soma, Baclofen, Robaxin, and Tizanidine. 

Topical medications may also relieve pain and are available in over the counter and prescription variations. Common over the counter formulations are Salonpas, Icy Hot, Bengay, and Aspercream, which bring localized pain relief to the location where they are applied. Prescription topical medications provide localized relief and include lidocaine, a numbing medication, and Diclofenac (Voltaren), an anti-inflammatory medication. Topical medications are good options for those that want to avoid or are unable to take oral medications.

Facet Joint Injections/Facet Blocks

Facet joint injections, commonly called facet blocks, supply steroidal medication to specific facet joints in the spine via a specialized needle. The medication is used to reduce inflammation and the associated pain at the joint. Relief can last up to several months, but injections can only be done up to three times in one year to avoid muscle or tendon breakdown.

Surgical Options

Cervical

An anterior cervical discectomy and fusion (ACDF) is a minimally invasive surgical stabilization procedure. This is performed through a small incision on the front of the neck. The surgeon moves the thin neck muscles until the spinal column is reached and the old disc and any disc fragments or bone spurs around the nerve root are removed. A special implant with bone graft is then placed in the space where the removed disc was, with screws to secure the implant. At the conclusion of this procedure, the specific disc level is fused and motion is no longer possible at this level.

Lumbar

Transverse lumbar interbody fusion (TLIF) is a minimally invasive stabilization procedure that fixes the appropriate disc level in the lumbar spine with a specialized implant. This procedure is performed through a small incision on the midline of the lower back. After reaching the spine, small amounts of bone are removed to reach the nerve roots, and if necessary, compression is removed from the nerve until the disc space is reached. The disc is removed and a special implant with bone graft is placed into the disc space with screws placed into the vertebral body above and below the disc space for support. The screws are connected via rods, fusing the spinal level, and motion is no longer possible, preventing further motion, inflammation, and pain.

A lateral lumbar interbody fusion (XLIF) is a minimally invasive lumbar spine surgery that requires special positioning with the patient’s left side upward. A small incision is made on the left, between the hip and the ribs. A thin wire, called a guide wire, is placed and sequentially larger, cylindrical tubes, called dilators, are placed through the psoas muscle to reach the left side of the spine. Once the spine is reached, the disc is then completely removed. A special implant is sized, filled with bone graft, and placed in the empty disc space. Screws are placed through the implant into the upper and lower vertebral body, to provide stability for the implant. This will fuse and stabilize the level to prevent further motion. The XLIF can only be performed on certain levels in the lumbar spine because the space between the hip and lowest rib is limited, but XLIF is preferred when bony anatomy does not allow for other approaches, when disease is confined to the facet joints without any nerve root compression, or when prior lumbar surgeries have left scarring or hardware that make it difficult to approach from the back.

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