Facets are a common diagnosis of back and neck pain. About thirty percent of patients with low back pain are known to have facet hypertrophy. Common symptoms are axial neck or back pain, increased pain with extension movements such as bending the neck or back backwards, and sometimes radiating symptoms which is usually in a spotty distribution and not consistent with a normal dermatomal pattern as experienced with nerve irritations from the spine. Also, many patients state that bending forwards seems to improve the pain. This is known as the shopping cart sign. For these patients, conservative treatment is often recommended but when the condition does not respond to such treatment, more aggressive intervention is indicated.
Radiofrequency ablation (RFA) is a very effective and long lasting approach to treating facet pain. The workup for RFA treatment includes diagnostic injections to confirm that the pain generator is in fact coming from the facet joints. These injections include nerve blocks or intra-articular injections into the actual facet joints. Relief of 70% or more is a positive finding. After the diagnosis is confirmed radiofrequency can be considered. The procedure consists of inserting probes to the area where the nerves lie and creating a lesion by burning nerves. This prevents the nerves from being able to communicate the pain signals to the brain. It is a minimally invasive procedure that provides long lasting relief (8-12 months). This procedure offers a method that lasts much longer than steroid injections and avoids complications that are experienced with steroids. The procedure essentially knocks out the pain completely by burning the nerves that are transmitting the pain. The procedure can be repeated in the future if necessary. The workup would need to be repeated to once again confirm the pain is coming from the facets. At Prairie Spine and Pain Institute, we are excited to offer this minimally invasive procedure to patients dealing with facet based pain.
About The Author: Derek N. Morrow, PA-C is a physician assistant with Prairie Spine and Pain Institute. Derek works in the clinic setting as a health care provider seeing patients. He is also utilized in the operating room as a first assist in surgery. In the clinic setting, his key function is to diagnose new patients and conduct their initial treatment. He works directly with patients to establish customized treatment programs and to monitor their progress. He also conducts history and physical evaluations for many patients. He performs many office procedures including trigger point injections, large joint injections, and bursa injections, all with the help of ultrasound guidance. He is radiologically trained, and uses his knowledge of X-ray, Ultrasound, MRI, CT, and EMG-Nerve Conduction Studies to establish a diagnosis and determine the appropriate treatment. Derek is surgically trained and plays a vital role in the procedures we perform at Prairie Spine and Pain Institute.
