FACET JOINT & SACRO ILLIAC

When back pain lasts beyond 4 to 6 weeks then further investigations are required to look for the source of pain i.e. disc, facet, nerves or soft tissues of the back.

Lumbar facet joint pain can be diagnosed clinically by eliciting tenderness over the facet joint or sacro-iliac joint and confirmed by using trial of blocks using local anesthetic with or without steroid. Once trial of blocks has been performed and the patient has had relief, longer pain relief is obtained by using radio frequency current, a procedure called radio frequency (RF) rhizotomy.

Cervical facet joint pain causes neck pain mainly on extension and rotation and may also spread to the proximal upper limb. Lower cervical facet pain can go down to the inter-scapular area. Cervical facet joint pain can similarly be treated by local anesthetic blocks followed by radio frequency (RF) rhizotomy.

Diagnosis is mainly clinical by eliciting lumbar or cervical facetal or/ and S.I. joint tenderness.

 

SYMPTOMS

 

 

 

 

 

 

 

 

 

 

 

INVESTIGATIONS
  1. X-ray may or may not show facetal hypertrophy or sclerosis of the S.I. joint. Lateral lumbar spine X-rays are also done to rule out spondylolisthesis.

  2. MRI of the lumbar spine in cases of facetal pain may show facetal hypertrophy or show normal facets.

TREATMENT OPTIONS
  1. Conservative – This involves spinal and sacro-iliac joint exercises. When pain is severe a course of physiotherapy (7-10 days) focused on the facet and S.I. joint can be recommended. The main risk factor of obesity has to be addressed simultaneously.  Running on hard surface and heavy weight lifting that aggravate the pain should be avoided.

  2. Medical Management – drugs like NSAIDs (e.g. Ibuprofen) may help for management of acute pain.

  3. Surgical Management –

    1. If conservative measures fail, then a minimal invasive spine procedure - trial of lumbar/cervical facet block - is undertaken. If the patient responds well to the facet block, and the pain is significantly reduced/disappears, then Radiofrequency (RF) rhizotomy is recommended for longer-lasting pain relief. In our series of more than 200 cases, pain relief lasts for 2 years on an average. The procedure can then be repeated. This period of pain-relief must be used for weight reduction and core spinal muscle building.

    2. If facet block fails to relieve pain, then spinal stabilization surgery can be undertaken which eliminates movement of the joint thus reducing pain.

  • Low Back Pain mainly, with some radiation to the thigh and rarely to the ankle. Facet pain is typically aggravated by lumbar spine extension and in some cases in flexion and rotation. Pain is aggravated by prolonged sitting and can be relieved by walking.

  • Neck pain of facet origin is aggravated by neck movement and is due to arthritis of the joint.

  • Leg Pain (sciatica) can also be a presentation of lumbar facet joint degeneration (arthritis) or sacro-iliac origin pain.

Disclaimer : The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only.

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