Facet Joint Mediated Pain, Spondylolisthesis
What is facet joint mediated pain?
Facet joints or Spondylolisthesis account for about 20% of chronic low back pain and up to 50 of neck pain. Although certain physical exam testing and historical information is helpful in making the diagnosis of facet joint mediated pain, only a series of spinal injections into the joint or the nerves that supply it can confirm this.
Arthritis of the Lumbar Spine (spondylolisthesis)
What is arthritis of the lumbar spine (spondylolisthesis)?
This is a condition in which a spine vertebral body slips forward or backward upon the vertebral body below. The word is derived from the Greek words spondylos, which means “spine” or “vertebra,” and listhesis, which means “to slip or slide.” If the vertebra slips too far forward, it can cause pain and nerve damage. Spondylolisthesis may vary from mild to severe. It can cause postural changes as it progresses.
Who is affected by spondylolisthesis?
Both children and adults can be affected.
What causes spondylolisthesis?
In children it is usually due to a small stress fracture of the pars interarticularis of the fifth lumbar vertebra due to repetitive stresses on the region. This occurs in 3-5% of the US population. As a result the fifth lumbar vertebra may slip forward on the sacrum.
In adults, the slip is most frequently between the fourth and fifth lumbar vertebrae. Common causes can be related to:
- Degenerative diseases, such as arthritis
- Traumatic fractures
- Bone diseases
What are symptoms of arthritis of the lumbar spine (spondylolisthesis)?
Symptoms may include:
- Pain in the lower back, thighs, and buttocks
- Stiffness in the back
- Muscle tightness
- Tenderness in the slipped area
- Neurological damage (leg weakness or changes in sensation) may result from pressure on nerve roots and may cause pain radiating down the legs
- Localized tenderness over the spine just above the pelvis
Some patients may not exhibit any symptoms with spondylolisthesis.
How is spondylolisthesis diagnosed?
X-rays will reveal the misalignment of the vertebra, and they can also show if there are any fractures.
How is it treated?
The most common treatments for spondylolisthesis are:
- Strengthening and stretching exercises
- Modification of activities
- Avoiding hyperextension of the back
- Avoiding contact sports
- Rigid brace when deemed necessary
- Surgery for the more severe cases to fuse the slipped vertebra
What are complications related to spondylolisthesis?
- Nerve compression
- Temporary or permanent damage of spinal nerve roots, which may cause sensation changes or weakness
- Chronic back pain
What can be done to help prevent further complications with
- Avoid back hyperextension (leaning too far back)
- Avoid weightlifting
- Avoid contact sports
- Seek medical attention if your child complains of back pain or stiffness, or pain in the thighs and buttocks.
If these techniques do not bring about the desired pain relief, we may perform a facet joint injection, which delivers a steroid or anesthetic to reduce inflammation and pain. It will also help to better diagnose the problem. We may also recommend other types of procedures such as medial branch blocks (diagnostic only) or prolotherapy.
If the facet joint injection provides temporary but not long-lasting relief, your physician may discuss the option of radiofrequency (lesioning) of the small nerves, which provide nerve impulses to the facet joints believed to cause your pain.
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