An estimated 1 in 10 Americans suffer from some form of back pain. And if you’re one of those unfortunate 30 million people, you know how inescapable it can be – affecting every aspect of your daily life.
As spinal specialists can attest, one of the most insidious – and often unpreventable – forms of back pain occurs when the spine’s facet joints degenerate.
“Facet joints are the structures that connect the spinal vertebrae to each other, and each vertebra has two facet joints. Each facet joint has cartilage lining that allows the bones to glide smoothly over each other and its function is to provide stability, mobility and support to the spine,” explained Dr. Michael Perry of the Laser Spine Institute.
When this cartilage becomes inflamed or irritated, people experience pain and difficulty moving.
And just as with other forms of osteoarthritis, facet arthritis occurs when a facet joint’s cartilage lining degenerates.
Typically, this occurs in the lower back and can happen for any number of reasons, including age, obesity, previous injury, overexertion and poor posture, among others.
Not surprisingly, facet arthritis is a common condition among the senior population – and is often diagnosed in those who are longtime golfers and/or tennis players.
“We see a lot of folks develop problems in their facet joints after participating for years in sports that necessitate rotational forces around the spine,” said Dr. John O'Connell, a physical medicine specialist with Cleveland Clinic Florida’s Center for Spine Health.
For physiatrists like O'Connell, the first treatment option for facet arthritis is conservative:
Topical ultrasound/electrical stimulation.
But if those protocols prove ineffectual, O'Connell noted that he’s had success performing a minimally invasive, non-surgical, non-narcotic injection procedure called radiofrequency ablation (RFA).
“I’ve done 24,000 of these procedures, and they’re usually pretty effective at significantly reducing a patient’s facet joint pain.”
The purpose of RFA is to deaden the sensory nerve of the specific facet joint that’s causing the pain.
“When the right nerve is deadened, it can’t send the pain signal to the brain,” O'Connell explained.
Here’s how the 30-minute outpatient procedure works: The patient is given a local anaesthetic and mild sedation. The doctor uses a fluoroscopic X-ray to guide into position a long, super-thin needle that’s charged with radiofrequency. After testing to make sure that the needle is in the exact spot to ablate the proper nerve, the injection of radiofrequency heats up to 176 degrees.
“Essentially, we’re ‘burning' the nerve ending,” O'Connell saud.
Other than minor topical soreness at the injection site, O'Connell said patients experience no side effects or downtime.
He explained that it usually takes a few weeks for the nerve to “fully die,” so the pain reduction isn’t maximized until then.
The pain-relieving effect of RFA typically lasts between six and nine months, and sometimes up to a year because the deadened nerve will regenerate.
“At that point, we can perform the procedure again.”
What O'Connell said he stresses to his patients is that “the goal of radiofrequency ablation is to make sure you have far fewer bad days.”