Facet joint treatments

The facet joints are small joints in the back, which link each bohne in the back (vertebra) to the next. There are 2 joints (right and left) linking each bone to the 0ne below. Movement of the spine causes the vertebrae to move in relation to the others around it and the facet joints allow this. Degeneration, also termed arthritis or wear and tear, can cause pain and give rise to facet joint syndrome. Facet pain can mimic sciatica and it is important to see a trained healthcare professional to establish a diagnosis. Imaging, including MRI, is often part of this process.

These joints are often thought of when back pain is related to movement. Maintaining activity and encouraging flexibility are core to treatment and reduction of pain. Where further treatment is considered, injections can be considered. These can be diagnostic or therapeutic,  aiming to both make a diagnosis and improve the pain. When injections are used to target the facet joint different approaches can be taken. Either the joint itself can be injected, just as a shoulder or knee would be, and this may involve anti-inflammatory medication such as steroid.

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The other approach taken is to target the small nerves that transmit the pain signals from the joint. These nerves are called the median branches. By stopping these nerves from working with local anaesthetic or other techniques, the doctor can be very clear about whether the facet joints are the cause of pain. These nerves, rather than the joint, can then be targeted to reduce and improve symptoms.

Where facet joint pain has been proven a procedure called Radiofrequency denervation can be considered which aims to remove the nerve and provide pain relief that lasts for longer.

NICE, the UK agency responsible for advising on treatments, now suggests median branch blocks be undertaken in patients with nonspecific low back pain and in where physiotherapy is not providing adequate relief.

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