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Seek-and-Destroy Mission for Facet Joint Pain

Low back pain is a common problem with many possible causes. One possible cause is the facet joint. Each bone in the spine (each vertebra) has several joints. The facet joints line up on the back of the spine, connecting vertebrae to each other. The facet joints glide across one another as the spine moves.

Pain from an ailing lumbar facet joint is usually caused by the changes of aging. Like other joints in the body, facet joints can become arthritic. The lining of the joint can become thin and worn from past injury and daily activity. Pain can be extreme because of the rich supply of nerve endings to the joint.

Isolating the problem to the facet joint can be difficult. There isn't one test that doctors can use to show that the problem is coming from the facet joint. The only way to know for sure is to block the nerve from sending and receiving signals to the joint. Blocking can be done using a local anesthetic injected into the nerve or joint.

Accurate injections are possible now with advanced imaging technology. The doctor can see to guide the needle to the exact spot. Patients can report results of the block before the doctor permanently destroys the nerve. If the pain is gone or reduced at least 50 percent, then the nerve to that joint is destroyed with a probe in a method called lumbar facet kryorhizotomy.

Kryorhizotomy is a new way to carefully destroy the precise nerve going to the facet joint. The first study from Switzerland has just been reported. This form of treatment is easy to use, safe, and can be done more than once if pain relief isn't complete. It works best for patients who haven't had a major back surgery in the past.

References: Christian B. Bärlocher, MD, et al. Kryorhizotomy: An Alternative Technique for Lumbar Medial Branch Rhizotomy in Lumbar Facet Syndrome. In Journal of Neurosurgery: Spine. January 2003. Vol. 98. No. 1. Pp. 14-20.

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