Facet joints are small joints that connect the bones of the spine called vertebrae. They come in pairs on each side of the vertebral bones. They allow for motion of the spine like bending and twisting. The orientation of the facet joint dictates the direction of the motion it allows.
There are various causes of pain coming from the facet joint. Similar to the joints in your arms and legs, the facet joints are prone to wear and tear. They can develop degenerative changes or joint osteoarthritis. This is a common condition in older people. The capsule surrounding the facet joint, which is made of ligaments and connective tissue, can be overstretched creating a sprain injury.Autoimmune or Inflammatory conditions like rheumatoid arthritis can also affect the facet joints by causing inflammation and deterioration.
Pain in the facet joints are typically felt in the local region of the affected joint segmetns. The pain can be felt close to the midline in the neck, upper back, mid-back or low back. Sometimes the pain is referred to the head, shoulder blade, shoulder, thigh or buttock. Stiffness, grinding in the joints (crepitus) and muscle spasm are other symptoms associated with facet joint disorders.
The standard treatment for facet joint pain include a course of physical therapy, non-steroidal anti-inflammatory medications, pain relieving medications, and home exercise program. When conservative measures fail, injection therapy to the facet joints or to the nerves leading to the facet joints can be helpful.
What is a Facet Joint Injection?
Facet joint injection is a minimally invasive procedure that is performed in an outpatient medical clinic. Local anesthesia is typically used in the procedure. There is no need for sedation in most cases. The procedure is performed under fluoroscopic (live digital x-ray) guidance. The typical substances that are injected to the facet joint are steroid medication to decrease inflammation and local anesthesia to provide immediate pain relief. The effects of these medications can provide temporary pain relief that typically last for 3-4 months.
Another injection that can provide pain relief does not involve injection to the joint, rather it involves the injection of numbing agents to the pain transmitting nerves (medial branch) called a nerve block.If this procedure results to a positive reponse,another procedure called Radiofrequency Ablation (RFA) can be performed. This involves inducing a heat lesion to the medial branches to prevent transmission of pain signals to the brain.
The use of Orthobiologicsis an alternative treatment to facet joint conditions. Although the research on these treatments for spinal conditions is relatively new, it has the potential to improve arthritis and provide long term pain relief.
Risks Associated with the Facet Joint Injection Procedure
Facet joint injections are relatively safe with minimal risks. Risks associated with this procedure may include:
Discomfort at the Injection Site: These effects are temporary and typically resolve in a few hours.
Adverse reaction to medications: Some of the medications used in the procedure can cause adverse reaction in susceptible individuals. It is important to review your medications with your physician prior to the procedure.Severe allergic reactions are rare.
Bleeding: Patients who are taking blood thinners or have a bleeding disorder are at risk for bleeding when undergoing an injection procedure.Blood thinners are typically stopped for 3-5 days prior to the procedure, with the permission of your primary doctor, to avoid this risk.
Infection: Infection is rare when the procedure is performed under strict sterile protocols and proper procedure technique.
Facebook Live Series
Live Question and Answer session with Regenerative Experts Topic: Herniated Disc and Annular Tear Date and Time: April 14, 2021. 12:30 PT
Join us on our Free Facebook Live Series called Ask the Docs. In this session, SDOMG physician experts will answer your questions on this common low back problem and non-surgical options to treat it.
Epidural steroid injection (ESI) is a minimally invasive procedure to help reduce inflammation and pain caused by spinal nerve root irritation.The spinal nerve can be irritated by compression caused by herniated discs, bone spurs, or narrowing of the spinal canal otherwise known as spinal stenosis. Pain, tingling, numbness, or weakness along the nerve distribution in the arms or legs are typical symptoms and are referred to as radiculopathy. This pain can persist for years if left untreated.
The goal of an epidural steroid injection is to help reduce inflammation along the nerve root. The procedure aims to reduce pain so patients can return to normal activity and participate in a rehabilitation program to strengthen the spine.
What is an Epidural Steroid Injection?
Epidural Steroid injections (ESI) involve injecting a solution of medication in the area between the bone and the protective layer of the spinal nerve called the epidural space. The medications consist of a potent anti-inflammatory called corticosteroids and a numbing agent like lidocaine.
Epidural steroid injections may be performed in the neck (cervical), middle back (thoracic), or lower back (lumbar).The injection is performed through the nerve canals on the side of the spine (transforaminal epidural injection) or through the middle of the spine (interlaminar epidural steroid injection).
What are the indications for this Injection?
Epidural steroid injections are used in patients who suffer from pain in the neck, mid-back, or low back which can radiate to the arms or legs. Patients who have the following conditions are candidates for epidural steroid injections:
Spinal Stenosis – narrowing of the spinal canal and nerve root canal.
Herniated Disc – the cushion between bones in the spine, called the intervertebral disc, can bulge or rupture through small tears and cause inflammation in the nearby spinal nerve.
Degenerative Disc – breakdown or aging of the spinal disc can cause a collapse of the disc, formation of bone spurs, and narrowing of the spinal canal.
Radiculopathy– irritation of spinal nerves due to nerve canal narrowing, disc bulge, or compression which causes pain to travel into the arms or legs, also known as “sciatica”.
An epidural steroid injection can also be used to determine whether surgery will be successful in patients who have a herniated disc.
Risks Involved with Epidural Steroid Injections
ESI procedures have been performed for many years and are considered safe and effective. Although uncommon, some patients may experience temporary side effects from the steroid medication in the form of facial flushing, insomnia, or irritability.
Serious complications are very rare, which may include an allergic reaction to the medications or contrast dye used, infection, nerve damage, or bleeding. When this procedure is performed properly with fluoroscopic guidance, the risks are minimized.This procedure is typically well tolerated by most patients and provides immediate relief that may last for up to 6 months.
For patients who are unable to obtain long-lasting pain relief or who wish to avoid the use of steroids, natural treatment options exist.These treatments use your own cells, helping with pain, and even may heal your injury.For more information, visit our website to learn more about PRP and cell therapy treatments.
The human spine is composed of 24 individual bones called the vertebrae. In between these bones are the intervertebral discs, which are gel filled structures that act as shock absorbers. They consist of a tough outer layer called the annulus fibrosus that protects the disc’s gel-like interior, the nucleus pulposus. In thelower back, the discsare a little more than a third of an inch (10 millimeters) thick and about 1.5 inches (four centimeters) in diameter.[i]
A bulging disc or herniated disc occurs when the outer layer of the disc weakens and tears. This can cause the inner gel to bulge out to the spinal canal and affect the nearby nerves causing back pain, leg pain or muscle spasm. The disc tear can also cause leakage of materials into the spinal canal that can cause inflammation and pain.
Herniated discs most often occur in the lower back but can occur anywhere in the spine, including the neck and the midback. The location of the herniated disc often determines where the patient will feel symptoms of pain, tingling, numbness or weakness. Bulging discs in the lumbar spine can result in pain in the low back, buttocks, thighs, legs and feet. On the other hand, if your herniated disc is in the cervical spine, pain can be felt in the neck, shoulders, arms and hands.
What Causes a Herniated Disc?
Disc herniation can occur due to injury or age-related wear and tear.As people age, the disc nucleus pulposus loses hydration, wears down and leads to degeneration.Other factors may increase the risk of developing a herniated disc. These include:
Repetitive lifting, pulling, pushing, bending and twisting
Genetics
Increased height (tall people)
Smoking (decreases blood supply to the disk leading to degeneration)
A thorough medical history and physical examination can lead to the diagnoses of disc herniation.An MRI of the spine is an imaging modality that reveals herniated discs and other structural abnormalities of the spine.
Treatment Options
The treatment for most cases of mild to moderate herniated discs involves conservative measures which include the following:
Activity modification: Avoid repetitive twisting, bending or lifting.Do not sit or stand for extended periods of time.
Physical therapy to strengthen your trunk, arm and leg muscles that support the spine.
Medications: Anti-inflammatory medications such as ibuprofen or naproxen, muscle relaxers, or pain killers
Ice packs or heating pads
Alternative therapies such as acupuncture, massage or gentle chiropractic manual therapies to manage pain.
Non-Surgical Interventions
When conservative measures fail to provide symptomatic relief, a board-certified spine specialist can offer injection treatments that do not require hospitalization and provide a more rapid recovery than surgery.
Epidural corticosteroid injection is a treatment that delivers steroid, a powerful anti-inflammatory medication, directly to the source of pain.This is performed using fluoroscopic (x-ray) guidance. This treatment can provide immediate relief of pain.The number of treatments is limited as repetitive steroid use could result to tissue damage, hormonal irregularities, osteoporosis and decreased immune response.
Cell-based therapies can treat disc degeneration and tears that are traditionally managed with medications or surgery. These treatments have been shown to increase disc hydration and disc cell proliferation, decrease inflammation, increase disc support tissue and assist in tissue healing. These therapies involve obtaining the patient’s own healthy cells and delivering them to the injured disc where they can jump start the body’s own regenerative healing processes.
Platelet Rich Plasma uses platelets in the blood that release growth factors and proteins to promote tissue repair, while the plasma carries the hormones, electrolytes and nutrients required to nourish cells during the healing process.
Cell Based Therapies use cells derived from the patient’s own bone marrow. Bone marrow contain adult stem cells that have the unique ability to develop into the specific kind of cells, including anulus and nucleus pulposus cells. They also contain many other healing cells and molecules that direct other cells in the area to form new blood vessels, awaken stem cells and produce collagen or other proteins essential for creating healthy new tissue.
Patients considering regenerative treatments such as these cell therapies need to know that the U.S. Food and Drug Administration (FDA) does not currently allow the use of stem cells derived from birth tissue products such as amniotic fluid or umbilical cord blood to treat orthopedic conditions. These donor products do not contain live stem cells and have not been tested for safety or efficacy.
Candidates for Cell-Based Therapies for Herniated Discs
The success of cell-based treatments for herniated discs is dependent upon the severity of your condition and your overall health. Cell-based treatments are not suitable for those who have active cancer, infection, history of blood disease, or are pregnant.
Cell-based therapies are giving new hope for long-lasting pain relief to many patients with injured discs. It is important that you take an active role in your healing and recovery with good nutrition and a commitment to overall fitness to achieve the best outcome.
Drs. Christopher J. Rogers and Mary A. Ambach of San Diego Orthobiologics Medical Group together have successfully treated thousands of patients with interventional spine proceduresand cell-based treatments for more than three decades. They are published authors and cell therapy researchers. Their facility in Carlsbad contains the most advanced Regenerative Medicine technology in San Diego and offers same- day treatments with the highest level of safety and efficacy.
On August 19, 2020, Dr. Christopher Rogers and Dr. Mary Ambach presented an education webinar on Neck & Low Back Pain: Using Your Own Cells to Heal your Body.
Neck and Low Back Pain Webinar
In this webinar, they discuss the causes of neck & low back pain, stem cell therapies, PRP therapies, and scientific research that provides evidence of safety and efficacy of these treatments. The in depth nature of this webinar is meant to be educational and provide people with knowledge and understanding of treatment options and what is available for specific types of chronic pain.
Low back pain is the fifth most common reason a patient visits their doctor.More than 90% of the population will experience at least one episode of low back pain during their lifetime.The social and economic impact of low back pain is significant and it is responsible for about 40% of missed work days in the US.
Causes of Back Pain
There are many different causes for low back pain. The pain can be acute or chronic in nature and may originate from an injury or degenerated tissues in the spine. Common causes of low back pain include:
Back strain: This occurs when the spine is subjected to physical stress that is greater than what can be supported by the muscular and ligamentous structures. Repeated heavy lifting or sudden awkward movements can cause over-stretching or tearing of the ligaments, tendons or muscles in the spine causing pain.
Arthritis. Osteoarthritis of the spine can lead to degeneration that is associated with the normal wear and tear of joints, discs and bones in the spine as people age. The arthritis can lead to bone spurs which result in narrowing of the space around the spinal nerves and spinal cord; a condition called spinal stenosis.
Facet joint dysfunction: The spinal column consists of individual bones called vertebrae.They connect to one another at each level by two small facet joints.The joints promote movement and stability between the vertebral bodies. Pain occurs when the joints get inflamed or when the cartilage in the joints becomes injured or worn out.
Bulging or Ruptured Disc: The discs are soft, gel filled structures that act as cushion or shock absorbers between the vertebral bones in your spine.The disc also connects the adjacent vertebrae together with strong fibrous tissue.When these discs become injured, they can bulge or the gel slips out and can put pressure on neighboring nerves causing pain. As people age, discs lose their hydration and wear down leading to degeneration. Degenerative discs can develop tears and collapse which causes low back pain, muscle spasm or spinal stenosis.
There are many other causes of low back pain including nerve and spinal cord problems, scoliosis, fracture and non-spine sources like tumor and kidney stones. It is important that your physician perform a comprehensive evaluation of your medical history and physical examination to give you an appropriate diagnosis for your back pain.
Non-Surgical Options for Back Pain Relief
There are hundreds of different forms of treatment for lower back pain, however no single treatment stands out as superior to any of the others. When conservative treatments fail to relieve pain, your doctor may feel compelled to consider surgery, however, the success rate of surgery is less than 60% for most causes of lower back pain and involves significant risk and recovery time. Fortunately, there are innovative, minimally invasive treatments available.
Advanced regenerative therapy may be the best solution for your back. These advanced treatments can help you heal faster. They avoid the risks and long-term complications associated with surgery and reduce pain to help you maintain an active lifestyle.
Platelet Rich Plasma (PRP) therapy concentrates platelets, plasma and other substances found in your blood to create a customized healing treatment for degenerative facet joints, discs and nerve pain.
Bone Marrow Aspiration Concentrate (BMAC) utilizes your own bone marrow which contains a rich reservoir of regenerative cells, multipotent stem cells and anti-inflammatory molecules designed to stimulate your body’s ability to improve circulation, decrease inflammation and regenerate tissues. This regenerative therapy can be used for disc tears, disc degeneration and facet joint arthritis.
Master Protease Inhibitor (A2M) uses a natural substance found in your blood (Alpha 2 Macroglobulin) to stop the progression of joint degeneration and improve pain and inflammation in arthritic joints.
Prolotherapy: Sugar containing medications that help regenerate tissue and relieve pain are injected into injured ligaments, tendons or joints to strengthen and improve stability in patients with osteoarthritis, ligament sprains, sacroiliac joint dysfunction and sports-related injuries.
Patients who have failed standard treatments or are seeking alternatives to spine surgery for neck and back pain should consider regenerative therapies. The research on the use of these therapies for certain conditions of the spine is very promising. However, much more research still needs to be completed. The doctors of San Diego Orthobiologics Medical Group contribute to advancing the science by participating in clinical trials and publishing articles on regenerative therapies for spine and other orthopedic conditions.
Advances in regenerative medicine offer new hope for long-term pain relief and improved quality of life.
San Diego Orthobiologics Medical Group is a leader in regenerative medicine therapies and offers a great variety of treatment options depending upon each patient’s unique needs. With decades of experience in the field of minimally invasive interventional treatments, Drs. Christopher J. Rogers and Mary A. Ambach are experts in the field of regenerative medicine. They serve as faculty members and lecturers at national and international medical conferences and serve on the board of directors for several national regenerative medicine organizations.
