Lumbar spine and neck pain have many causes. One of the most common causes stems from the facet joints in the spine. The facet joints are small joints on both sides of the upper and lower parts of the vertebrae of the spine which act to provide stability to the spine.

Common Causes of Facet Joint Pain
1. Disc space narrowing - most common cause
2. Chronic inflammation
3. Mechanical stress
4. Bony facet joint abnormalities

Signs and Symptoms of Facet Joint Disease
1. Deep, dull aching pain in the low back can travel to the buttocks, hips, front or back of the thighs. In the case of neck pain, symptoms can travel to the back of the head and shoulders.
2. Often pain worsens when arching the back or neck backwards and turning side to side.
3. Often pain improves with flexing the back and neck forward.
4. There can be muscle spasm over the painful facet joint
5. Back pain usually improves when you are off your feet and worsens when you are on your feet.

Radiology Studies to Help Decide if you have Facet Joint Disease
X-rays, MRI scans, CT scans and bone scans can be helpful in pointing to the facet joints causing your pain. These studies can be normal in patients suffering from facet joint pain. Your Pain Management doctor can help determine if facet joints are the cause of your back  or neck pain.

To determine if the facet joints are the cause of your pain, the suspect facet joints are injected under x-ray vision with local anesthetic and possibly a steroid medication to decrease inflammation. Experiencing relief indicates the injected joints are most likely the source of your pain. These injections can provide long-term pain relief. If the pain returns, the facet joints may be injected again. If there is temporary relief again with subsequent return of pain and no surgically correctable problem, radiofrequency facet nerve lesioning may be recommended to provide long term relief of your pain. This term refers to the interruption of the sensory nerves of the facet joint using radiofrequency energy. This does not cause numbness or weakness in the arms or legs.

How is radiofrequency facet nerve lesioning done?
You will be asked to lie on a special x-ray table and given light intravenous sedation. Using fluoroscopy (live x-ray), the bony landmarks will be located where the facet nerves are known to lie. Under local anesthesia, a needle with an electrode connected to the radiofrequency machine will be passed to the bony landmark as shown in the diagram. The needle position is adjusted until it is precisely at the nerve site as shown by the monitors on the machine. The nerve is then stimulated lightly to confirm that the needle is in the right position. After the nerve is anesthetized, it is then heated to 80°C for 90 seconds causing interruption of the nerve fibers.

Anesthetic is then injected at the lesion site so that you are comfortable. Each facet nerve has two or three nerves that must be lesioned dependent on the facet joint.

What to Expect
You may have some muscle tightness and soreness at the needle sites which may last for several days. This can be treated at home by placing a cold pack over the needle sites for fifteen minutes every two hours for the next 12 hours. Do not drive a motor vehicle for 24 hours.

After 24 hours, any muscle tightness can be treated with a heating pad or by directing water from a hot shower to the area of soreness. If this is not effective, medication can be prescribed for you. Food and liquid consumption can usually be resumed soon after the procedure. Please do not perform any vigorous activity for one week. When you are feeling better, slowly increase your activity and exercise.

Radiofreqency treatment usually interrupts pain signals for a prolonged period of time. However, your body may regenerate these pain pathways over time. If your pain does return the procedure may need to be repeated.