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 in 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 by 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 (RFA).  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 nerve) that provides the painful sensation from the facet joints to the brain is interrupted.  Radiofrequency can offer more long term relief of the cervical or lumbar region, and even other peripheral nerves.

 

What is Radiofrequency Ablation? 

Radiofrequency neurotomy is a safe, minimally-invasive procedure using a specialized machine and insulated needles with a probe to deliver high-frequency, low voltage radio waves that convert to heat that interrupts and eliminates the sensation of the pain from the target nerves.  Thermal radiofrequency interrupts the painful stimuli.

 

How is Radiofrequency Ablation Performed? 

The procedure is performed in a special fluoroscopy room utilized only for xray-guided injections.  The needle is positioned using bony landmarks seen on the x-ray that identify the nerve location. 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 Neurotomy Painful? 

Patients typically tolerate the procedure very well. Occasionally, if very nervous, we'll provide the patients with oral xanax to relax them during the procedure.  I utilize lots of numbing medicine in order to minimize any pain from the needle movement (much like a dentist does).  

 

How Long Does The Relief Last from Radiofrequency Ablation? 

The results with radiofrequency may vary depending on the severity of arthritis, progression of arthritis between treatments, and lifestyle choices.  Results are also dependent on an accurate diagnosis made with nerve blocks that would indicate concordant pain relief.  Typically, we expect an average of 12 months of pain relief, however we've seen as short as 6-9 months or as long as 18+ months.

 

Is Radiofrequency Ablation Safe? 

Radiofrequency ablation 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 that claim it is “experimental” and not covered despite efforts to provide documentation with multiple peer-reviewed scientific studies. 

 

 

Lumbar Facet Arthritis

 

Lumbar refers to the area of the lower back between the lowest ribs and the pelvis (L1-L5).  These joints help protect the spine by giving it stability to limit it from excess motion.  There are specific nerves called medial branch nerves that carry sensation from each joint to the brain.  There are many causes that may contribute to facet joint pain.  Most commonly, facet arthritis is a result of degenerative changes called spondylosis.

 

Prevalence of Lumbar Facet Pain

There are many publications that describe the complexities of facet pain. To mention a few, Schwarzer et al showed that in younger aged, injured workers 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. when in 2001, they 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 unfortunately no physical examination 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).

 

Diagnosing Lumbar Facet Joint Pain

The only accurate method of diagnosing facet joint pain is a 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 physical examination features cannot be used to accurately diagnose the condition, there are certain clinical features that increase the likelihood of facet joint pain being positive.  Morning stiffness and pain is a common problem for patients with facet joint arthritic pain.  This pain is usually better when sitting, and worse with anything activity that causing extension (arching backwards) in the low back.

 

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 via 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.  

 

When the common clinical features noted above 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 numbning block provides significant relief for 3-5 hours, 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 nerve) that provides the painful sensation from the facet joints to the brain is interrupted.  Radiofrequency can offer more long term relief of the cervical or lumbar region, and even other peripheral nerves.

 

What is Radiofrequency Ablation? 

Radiofrequency neurotomy is a safe, minimally-invasive procedure using a specialized machine and insulated needles with a probe to deliver high-frequency, low voltage radio waves that convert to heat that interrupts and eliminates the sensation of the pain from the target nerves.  Thermal radiofrequency interrupts the painful stimuli.

 

How is Radiofrequency Ablation Performed? 

The procedure is performed in a special fluoroscopy room utilized only for xray-guided injections.  The needle is positioned using bony landmarks seen on the x-ray that identify the nerve location. 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 Neurotomy Painful? 

Patients typically tolerate the procedure very well. Occasionally, if very nervous, we'll provide the patients with oral xanax to relax them during the procedure.  I utilize lots of numbing medicine in order to minimize any pain from the needle movement (much like a dentist does).  

 

How Long Does The Relief Last from Radiofrequency Ablation? 

The results with radiofrequency may vary depending on the severity of arthritis, progression of arthritis between treatments, and lifestyle choices.  Results are also dependent on an accurate diagnosis made with nerve blocks that would indicate concordant pain relief.  Typically, we expect an average of 12 months of pain relief, however we've seen as short as 6-9 months or as long as 18+ months.

 

Is Radiofrequency Ablation Safe? 

Radiofrequency ablation 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 that claim it is “experimental” and not covered despite efforts to provide documentation with multiple peer-reviewed scientific studies.