LOW BACK PAIN coming from joint

Lumbar facetogenic pain is a type of lower back pain that originates from the facet joints in the lumbar spine. The facet joints are small stabilizing joints located between and behind the vertebrae, helping to provide stability and motion in the spine. So, imagine traveling forward from the skin on your back toward your navel. First, you have skin, fat, and layers of muscles, called paraspinal muscles. Then you come to the bone and facet joints between parts of these bones. Then you pass through the hard bone and enter the spine, where there is a space called the epidural fat. This epidural fat contains nerves on both sides but not in the midline. Then there will be cerebrospinal fluid (CSF). Then you see the spinal cord. In other words, all of these structures will protect your spinal cord. Then, in front of it, you have the vertebrae, which are stacked on top of each other like layers of a bun. Sandwiched between 2 buns is the disc.

This structure not only provides mobility but also offers protection for your spinal cord and nerves.

Key Features:

• Pain location: Pain is typically localized to the lower back and may radiate to the buttocks or thighs, but rarely extends below the knee.
• Pain characteristics: Often described as dull, aching, or sometimes sharp. It may worsen with certain movements, such as twisting or bending backward (extension) or prolonged standing.
• Mechanical nature: Movements that increase the load on the facet joints (such as arching the back) can exacerbate the pain, while rest might relieve it. However, like any other form of arthritis, the facet joints may cause stiffness in your back when you wake up in the morning or upon getting out of the car after a prolonged sleep.

Causes:

• Degeneration: Age-related wear and tear of the facet joints (facet joint osteoarthritis).
• Injury or trauma: A direct injury to the lumbar spine can trigger facet pain. We believe that a sudden jolt to the vertebrae, when you do not expect it, such as being thrown forward or to the sides when your car is rear-ended or T-boned, can irritate the facet joints.

Evaluation:

• Examination: A doctor may perform specific physical tests, such as movements that stress the facet joints, to provoke the pain.
• Imaging: X-rays, CT scans, or MRIs can help visualize any degeneration or abnormalities in the facet joints.
• Diagnostic injections: A precise injection of an anesthetic into the facet joint or surrounding area can help confirm the diagnosis by temporarily relieving the pain.

Treatment:

• Conservative management:
  • Physical therapy to strengthen muscles around the spine and improve posture.
  • Anti-inflammatory medications (NSAIDs) or muscle relaxants. They are prescribed for a few days. More prolonged use of these medications may seriously damage your body.
  • Activity modification and ergonomic adjustments.
• Injections:
  • Facet joint injections: A combination of a steroid and an anesthetic to reduce inflammation and pain. Although it may be effective for some people, we cannot repeat these injections more than a few times, as these injections will cause side effects.
  • Platelet Rich Plasma (PRP): It is a very safe and effective form of treatment for pain arising from joints and surrounding structures.
  • Radiofrequency ablation: A procedure where either vibration or heat is used to hibernate the small nerves causing pain, providing longer-term relief. These nerves are not needed for any form of movement or sensation other than the feeling of established pain. If something bad happens to you and you have a new injury after you were already treated, you are still able to feel the new pain.  
• Surgical options (rarely needed under very special circumstances, such as concurrent nerve impingement): Facet joint surgery may be considered if conservative treatments fail, and the pain severely impacts daily functioning.

How is the facet injection done?

These joints are the most superficial part of your spine. The spinal cord and big nerves are deeper structures. It means the risks of any significant nerve damage are very low. We use live X-ray to see the joints and the needle path approaching and getting into these joints.