An estimated one in 10 Americans suffer some form of back pain.
If you’re one of those unfortunate 30 million people, you know how inescapable it can be, affecting every aspect of your daily life: Sleeping, driving, working.
And as spinal specialists can attest, one of the most insidious — and often unpreventable — forms of back pain occurs when the spine’s facet joints degenerate.
“Facet joints are the structures that connect the spinal vertebrae to each other, and each vertebra has two facet joints. Each facet joint has cartilage lining that allows the bones to glide smoothly over each other, and its function is to provide stability, mobility and support to the spine,” said Dr. Michael Perry of the Laser Spine Institute.
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When this cartilage becomes inflamed or irritated, people experience pain and difficulty moving.
Just as with other forms of osteoarthritis, facet arthritis occurs when a facet joint’s cartilage lining degenerates.
Typically, this occurs in the lower back and can happen for any number of reasons, including age, obesity, previous injury, overexertion and poor posture.
Not surprisingly, facet arthritis is a common condition among older people and is often diagnosed in longtime golfers and tennis players.
“We see a lot of folks develop problems in their facet joints after participating for years in sports that necessitate rotational forces around the spine,” said Dr. John O’Connell, a physical medicine specialist with Cleveland Clinic Florida’s Center for Spine Health.
The first treatment option for facet arthritis is conservative: Ice, heat, massage, acupuncture, manipulation, topical ultrasound/electrical stimulation and over-the-counter painkillers.
If those protocols don’t work, O’Connell said, he has had success performing a minimally invasive, non-surgical, non-narcotic injection surgery called radio-frequency ablation.
“I’ve done 24,000 of these procedures, and they’re usually pretty effective at significantly reducing a patient’s facet joint pain,” he said.
The purpose is to deaden the sensory nerve of the specific facet joint that’s causing the pain.
“When the right nerve is deadened, it can’t send the pain signal to the brain,” explained O’Connell.
Here’s how the 30-minute outpatient procedure works: The patient is given a local anesthetic and mild sedation. The doctor uses a fluoroscopic X-ray to guide into position a long, super-thin needle that’s charged with a radio frequency. After testing to make sure that the needle is in the exact spot to ablate the proper nerve, the injection of radio frequency heats up to 176 degrees.
“Essentially, we’re ‘burning’ the nerve ending,” O’Connell said.
Other than minor topical soreness at the injection site, he said, patients experience no side effects or down time.
He saidit usually takes a few weeks for the nerve to “fully die,” so the pain reduction isn’t complete until then.
The pain-relieving effect of RFA typically lasts between six and nine months, and sometimes as long as a year (the deadened nerve will regenerate).
“At that point, we can perform the procedure again.”
He said he emphasizes to patients is that “the goal of radio-frequency ablation is to make sure you have far fewer bad days.”