The facet joint is on the back of the spinal vertebrae, and acts like a hinge between vertebral segments. Facet joints are located between each vertebra and provide flexibility to the spine that allows you to bend and twist your back.

 

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Each vertebra has two sets of facet joints, one facing upward (superior articular facet) and one downward (inferior articular facet) on each side (right and left). These joints act like hinges linking the vertebra together to form your spine. In order for the facets to be an effective hinge, each cartilage-coated joint is surrounded by a capsule of connective tissue and fluid that lubricates the joint allowing them to smoothly glide against each other. The nerve supplying the joint is called a medial branch.

Sometimes, facet joint problems can develop from arthritis or injury.

Facet joint and medial branch blocks are used for patients with pain stemming from inflammation or irritation of the facet joints. These patients normally do not respond to other conservative means, such as oral anti-inflammatory medication, rest, or physical therapy.

These procedures usually are performed for management of severe acute or chronic pain affecting the back or neck. They may also be performed for testing purposes by providing valuable diagnostic information about your condition. For example if your back pain or neck pain responds to a therapeutic injection, that can provide valuable information to the surgeon that a specific facet joint level is actually the pain generator.

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A facet block is an injection of local anesthetic and steroid into the facet joint in the spine. A medial branch block is similar but the medication is placed outside of the joint near the nerves that supply the joint called the medial branch.

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Based upon your symptoms or diagnostic tests that show an internal image of your spine, the injection can be directed into the facet joint or can target the nerves close to the joint, thus, a facet joint block or facet joint nerve block, called a medial branch block.

During the injection procedure, the patient lies face down. Using a C-arm for X-ray guidance, the spinal injectionist identifies the specific level of the spine that will receive the injection. After cleaning the skin and placing sterile drapes, the physician numbs a small area of skin. Most patients will note that the initial sensation of the numbing medicine is perhaps the only discomfort felt from the injection procedure.

Using X-ray guidance of the C-arm, the physician then guides a small needle to either the facet joint or the medial branch. In confirming the correct needle placement, the injection may initially create a response, which could be identical to the pain under investigation, similar but not identical, or a different or new sensation. The medication is then injected around the facet joint or near the nerves supplying the joint.

There will be a short recovery time in a nearby room where you may sit in a recliner and your blood pressure will be checked and you will be monitored for any complications or side effects. Typically, you will be allowed be be driven home within an hour.

Facet joint blocks or medial branch blocks can provide pain relief that lasts from days to years. If you get good, lasting benefit from the injections, the procedure may be repeated. If you get good, short-term benefit, you could be considered for another procedure called facet rhizotomy (radiofrequency ablation), which may provide longer-term relief of months to years. If you do not get any benefit from the procedure, the block still has diagnostic value in that it means that the pain is likely not coming from the targeted facet joints.

Spinal fractures are different than a broken arm or leg. A fracture of a spine vertebra can cause bone fragments to damage spinal nerves or the spinal cord.

A spinal fracture can occur from a fall, a car accident, or when an object impacts the spinal vertebrae with a force that it cannot withstand, so the bone cracks.

The most common type of spine fracture is a vertebral body compression fracture, which is downward force that shatters the structure of the vertebrae. If the force is great enough, it may send bone fragments into the spinal canal, called a burst fracture.

Most spinal fractures occur from severe trauma to the body from car accidents, falls, and other high impact force to the body. Injuries can range from spine vertebra fractures or as serious as debilitating spinal cord damage that can cause permanent paralysis.

Some smaller fractures can heal with physical therapy treatment and rest, however severe fractures will require surgery to reposition the bones and can include paralysis if the injury damaged the spinal cord. Spinal fractures and dislocations can pinch, compress, and even tear the spinal cord.

Fractures can occur anywhere along the spine, including the cervical, thoracic, and lumbar areas of the spine.

Spondylolysis relates to instability of specific bones in the low back. It a very common cause of back pain, particularly in adolescents. Gymnasts who perform routines that bend and arch the back are often victims of spondylolysis or spondylolisthesis.

 

Causes

Spondylolisthesis and spondylolysis are caused by joint instability in the low back. The rear part of spinal vertebrae has facet joints that act as hinges, allowing our spines to twist and bend. Sometimes, however, the posterior element can crack. Either from heredity or wear and tear, part of the posterior element called the pars interarticularis can crack, causing the vertebrae to slip forward out of its correct position. Spondylolysis occurs when the PARS hinge is cracked, but the vertebrae is still in its correct position. Spondylolisthesis occurs when the cracked PARS has allowed the vertebrae to slide forward out of its correct position. If left untreated, spondylolysis can lead to spondylolisthesis.

Symptoms

Interestingly, in many cases, spondylolisthesis may have no symptoms, so most people may not know they have it. Back pain is the most common symptom, particularly in the lower back. This back pain may be mistaken for a muscle strain. Muscle spasms that occur as a result of spondylolysis may cause an overall feeling of stiffness in the back and may effect posture.

Diagnosis

Outlined below are some of the diagnostic tools that your physician may use to gain insight into your condition and determine the best treatment plan for your condition.

• Medical history: Conducting a detailed medical history helps the doctor better understand the possible causes of your back and neck pain which can help outline the most appropriate treatment.

• Physical exam: During the physical exam, your physician will try to pinpoint the source of pain. Simple tests for flexibility and muscle strength may also be conducted.

• X-rays are usually the first step in diagnostic testing methods. X-rays show bones and the space between bones. They are of limited value, however, since they do not show muscles and ligaments.

• MRI (magnetic resonance imaging) uses a magnetic field and radio waves to generate highly detailed pictures of the inside of your body. Since X-rays only show bones, MRIs are needed to visualize soft tissues like discs in the spine. This type of imaging is very safe and usually pain-free.

• CT scan/myelogram: A CT scan is similar to an MRI in that it provides diagnostic information about the internal structures of the spine. A myelogram is used to diagnose a bulging disc, tumor, or changes in the bones surrounding the spinal cord or nerves. A local anesthetic is injected into the low back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected into the spinal canal to reveal where problems lie.

• Electrodiagnostics: Electrical testing of the nerves and spinal cord may be performed as part of a diagnostic workup. These tests, called electromyography (EMG) or somato sensory evoked potentials (SSEP), assist your doctor in understanding how your nerves or spinal cord are affected by your condition.

• Bone scan: Bone imaging is used to detect infection, malignancy, fractures and arthritis in any part of the skeleton. Bone scans are also used for finding lesions for biopsy or excision.

• Discography is used to determine the internal structure of a disc. It is performed by using a local anesthetic and injecting a dye into the disc under X-ray guidance. An X-ray and CT scan are performed to view the disc composition to determine if its structure is normal or abnormal. In addition to the disc appearance, your doctor will note any pain associated with this injection. The benefit of a discogram is that it enables the physician to confirm the disc level that is causing your pain. This ensures that surgery will be more successful and reduces the risk of operating on the wrong disc.

• Injections: Pain-relieving injections can relieve back pain and give the physician important information about your problem, as well as provide a bridge therapy.

Treatment

Conservative treatments should always be considered first when treating spondylolysis. Nonsurgical treatment methods include resting and refraining from usual activities, taking anti-inflammatory medication, and incorporating a stretching and strengthening program. While ligaments and muscles can help hold the vertebrae in place, over time, surgery may be necessary to install surgical instrumentation or bone grafts that lock the vertebra in place so that it does not slide out of position and damage the spinal nerves. Surgery may involve a fusion and/or screws and rods.

How do I know if I am at risk for spondylolysis?

Those with a family history of spondylolysis or weak vertebrae are more susceptible to developing the condition. Also, athletes involved in activities that place a great deal of stress on the back, such as football players and weight lifters, are at greater risk for fracturing the vertebrae, encouraging slippage.