The human spine is comprised of 33 individual bones stacked on top of one another. The spinal column provides the main support for the human body. The segments that comprise the spinal column are cervical, thoracic, lumbar, sacral and coccyx. Only the top 24 vertebrae are movable as the sacrum and coccyx are fused. Discs sit between the vertebral bodies and act as shock absorbers. Facet joints are the joints in the spine where movement occurs. The facets are where vertebrae are connected to one another. The facet joint is a true synovial joint with an articulating surface and surrounded with synovial fluid.
By definition, a facet joint is a smooth flat circumscribed surface of a bone. These areas are a common source of low back pain.
Low back pain is a common clinical condition occurring in up to 85% of all people at some times in their lives. Determining the etiology of low back pain is a complex diagnostic dilemma. Lumbar disc herniation has ben considered by clinicians to be the leading source of low back pain. However, several recent studies have shown that LBP is caused by facet synovitis and facet arthritis in at least 45% of these patients. Another study of patients with LBP documented that 40% or more had pain secondary to facet disease that was proven by anesthetic blocks to the facet area, alleviating the symptoms.
MRI has been the primary modality for the diagnosis of facet disease. It generates images with extensive soft tissue high resolution and bone deformities can be easily detected. This permits the evaluation of active facet joint effusion, synovitis, bone edema, impingement and osteophyte formation. MRI can accurately detect these facet joint and adjacent soft tissue abnormalities.
Treatment modalities of chronic pain arising from facet joint disease include medial branch nerve blocks, radiofrequency nerve ablation and intra articular injections. Lumbar facet injections can be both diagnostic and therapeutic. Commonly, an anesthetic such as Lidocaine or Marcaine is injected in and around the affected facet area. If the patient has relief of their symptoms, then the test is considered positive and further injections are given for a therapeutic option. These injections are given with a fluoroscopy guided technique considered the most accurate and reliable.
The most common injection given as a therapeutic modality is corticosteroid. However, intra-articular steroids have various effects including steroid induced hyperglycemia, hypertension, gastrointestinal symptoms, exacerbation of cardiac disease, vertigo and others. Other studies have proven steroids degrade joint structure. Therefore, there have been studies identifying injectable alternatives to steroids, ones that are safe and efficacious for facet disease.
Platelet Rich Plasma is an autologous blood concentrate obtained from the patients own blood. It is rich in cytokines and growth factors which have been proven to have a great healing and regenerative potential. As an autologous concentrate, PRP does not exhibit adverse effects typically seen with other injectables. PRP is inexpensive, easy to prepare and minimally invasive and was evaluated as an alternative to commonly used injectables for facet joint treatment.
- The Role of Intra-Articular Injection of Autologous Platelet Rich Plasma Versus Corticosteroids in the Treatment of Synovitis in Lumbar Facet Joint Disease
Saudi Medical Journal Nov 2022, 43(11) 1200-1208 doi.org/10.15537/smj.2022.43.11.20220449
Objectives: To compare the efficacy between platelet rich plasma and corticosteroids in improving magnetic resonance imaging detected synovitis in correlation with clinical complaints among patients with lumbar facet disease
Results: Both groups showed a significant improvement in all mentioned parameters at follow up after 3 months. However, PRP injections promoted better performance in terms of MRI synovitis grade in all lumbar facet joint levels compared to corticosteroid injections.
Conclusion: PRP may be a better treatment option for longer duration efficacy
- A Prospective Study Comparing Platelet Rich Plasma and Local Anesthetic /Corticosteroid in Intra-Articular Injection for the Treatment of Lumbar Facet Joint Syndrome
Pain Prac 2017 Sept;17(7):914-924 PMID 27989008
Objectives: To compare the effectiveness and safety between autologous platelet rich plasma and local anesthetic /corticosteroid in intra articular injection for the treatment of lumbar facet joint syndrome
Results: Group A was the PRP group and Group B was the corticosteroid treated group.
Both groups had the highest objective success at 1 month. (80% and 85%) But only 50% and 20% at 6 months. However, the Group A (PRP), increased over time.
Conclusion: Both PRP and corticosteroid for intra articular injection are effective, easy and safe enough in the treatment of lumbar facet syndrome. However, autologous PRP is a superior treatment option for longer duration efficacy.
Curr Pain Headache Rep 2019 Jul 3;23(7):52 PMID 31270622
Purpose of review: Back pain is a growing problem worldwide, incurring enormous economic costs and disability. Current treatment modalities often provide adequate relief but fail to address underlying conditions. Regenerative cellular modalities aim to restore anatomical function in degenerative conditions which may cause low back pain. Platelet rich plasma consists of an increased concentration of autologous platelets suspended in a small amount of plasma. PRP can be administered via injection.
Findings: A small number of prospective trials have suggested there may be some benefit to using PRP injection in the treatment of pain or functional decline caused by facet joint arthropathy.
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA cleared and designed for safety, sterility and effectiveness. Our kits have been scientifically manufactured to provide a consistent platelet concentrate, devoid of red blood cells with a minimum number of leukocytes, critical to the regenerative process.
Juventix Regenerative Medical offers a patent pending LED activator to activate the platelets and begin the regenerative process. The activation is a critical step in the release of cytokines, growth factors and bioactive proteins and is accomplished with LED light. This negates the use of chemical additives such as Calcium Chloride, Thrombin or Collagen.
Juventix Regenerative Medical supplies a bio-incubator that transforms the Platelet Rich Plasma into an Injectable Platelet Rich Fibrin. The Platelet Rich Fibrin, commonly called the “second generation of platelet products” has different growth factors and cytokines than the original PRP. These different cytokines provide a broader range of clinical applications due to their anti-inflammatory properties.
Juventix Regenerative Medical offers many more products and services for the regenerative professional. Our newest collaboration is with Evolutionary Biologics who supply exosomes and other cellular regenerative products.