Navid Farahmand, M.D., specializes in interventional pain management. Based in Beverly Hills, California, he uses techniques like facet joint injections and other non-surgical techniques to manage conditions like facet arthritis which cause pain in the spine.
Facets ― or more correctly, facet joints ― are small joints located between and behind the bones of the spine (vertebrae). Each pair of vertebrae has two facet joints. The purpose of the facet joints is to provide stability to the spinal column while also allowing flexibility. It is the facet joints that allow the spine to flex, extend, rotate and bend to the side. Each joint is encased in a joint capsule, which contains fluid that lubricates and protects the joints.
Facet joints move almost constantly, which can cause them to wear out or degenerate. As they wear, the cartilage between the joints can break down, or the joints themselves can grow excess bone, known as facet joint hypertrophy. These changes to the facet joints are more commonly referred to as facet joint arthritis. Facet joint arthritis typically takes many years to develop, as it is usually related to wear and tear over a period of time. However, acute injuries can also cause facet joint pain by overstretching the facet joint capsule, triggering the same inflammatory cascade seen with facet joint hypertrophy.
Facet joint pain is typically felt not in the center of the spine, but rather within a few inches of the midline. It is usually dull and ill-defined in character. In the neck, it can radiate into the head and cause headaches, or it can go side to side as well as up and down the neck and into the shoulder blades and towards the shoulders, but does not go down the arms. Similarly, in the low back, it is felt a few inches off the midline. It typically radiates side to side and parallel to one’s waist, and can felt into the buttock and down the back of the legs, stopping above the knees. It tends to be worse first thing in the morning and is exacerbated by standing, as well as rotation and extension of the spine.
Facet joint arthritis is usually treated conservatively (without surgery). Examples include physical therapy, heat, ultrasound, stretching, iontophoresis, and chiropractic treatment. Medications to relieve inflammation, pain and muscle spasm may be helpful. Although nothing can be done to repair or undo the arthritic changes that occur within facet joints, there is an effective form of nonsurgical treatment called radiofrequency ablation (RFA) where the nerves responsible for transmitting pain signals from the facet joint to the brain can be heated up and turned off for a long period of time. By shutting down the pain signal before it reaches the brain, the sensation of pain is eliminated. Surgery to fuse the facet joints and eliminate painful range of motion is rarely recommended.