This is Dr. Robert McGrath and I am the Medical Director at Juventix Regenerative Medical
BACK PAIN, the cost of this problem in the US is staggering. 80% of the general population will suffer a severe episode of low back pain at least once in their lifetime. Total of $3.1 trillion dollars or 17.9% of the total GNP of the US was spent on healthcare by individuals and health insurance companies with a great majority related to back, neck and musculoskeletal disorders.
Low back pain and neck pain tops US healthcare spending. Americans spent $380 billion on Low back pain and neck pain alone in 2016.
- Diabetes $111 billion
- Heart Disease $89.3 billion
- Falls $87.4 billion
Each year $100 billion is spent on work related back disorders. Loss of business and productivity is estimated at $225.8 billion per year. As one of the most common medical problems worldwide- facet joint syndrome is a common cause of all cases. Research estimates of facet joint causing low back pain to be 15% to 59.6% in men and 66.7% in women. While facet pain frequently causes pain in the lumbar area, it is estimated to be the cause of 30-70% of neck pain and 33-48% of thoracic pain
The facet joints are joints between the articular processes of two adjacent vertebrae. The function is to provide healthy movement and stability for each vertebrae. Along with the disc between the vertebral bodies, the facets are part of a triad to guide and limit movement in each spinal motion segment. They have a different alignment in the cervical, thoracic and lumbar areas. The joint surfaces of the articular areas are coated with cartilage and encapsulated by a fluid filled synovial membrane to prevent friction and promote smooth movement. Cavitation of the synovial fluid in the joints is responsible for the “popping sound” heard during spinal manipulation.
As true joints, the facets are prone to degeneration, fracture, injury, osteoarthritis and traumatic injury. Degenerative changes are extremely common as we age due to the mechanical nature of these joints. These joints are innervated by nerves which transmit pain signals and thus the discomfort felt when these areas are inflamed.
The facet joints are subjected to great amounts of shearing forces and compression from daily living and movements. The joints can be symptomatic due to:
- Chronic low back injury due to overuse
- Trauma from an accident, MVA or sports related
- Disc disease and other ligamentous degeneration due to age
- Poor body mechanics and posture
Pain may originate from the inner or outer surface of the facet joint
- Outer capsule is comprised of connective tissue and ligaments that can be injured or degenerate with age
- Inner capsule- inflammation caused by degeneration and loss of cartilage
Disc surgery causes decrease in overall height causes articulation surfaces to come closer together altering normal facet mechanics. All joints undergo degenerative changes with age due to their mechanical nature. The facet joint is extremely vulnerable to changes. They can become enlarged and swollen much like an arthritic knee. The nerves become entrapped. This process is called facet arthritis or facet arthropathy.
Diagnosis of facet injury or disease is complicated. Pain associated with facet problems can be local or referred. The location of facets covered deep by the paraspinal musculature make the diagnosis complicated. Physical exam can be complicated and confusing. Usually a MRI or CT is ordered. Diagnostic anesthetic blocks can also be used to confirm the origin of the pain associated with facet problems.
Cervical Facet Joint Symptoms
- Difficulty with rotation of the head
- May refer pain to neck and shoulders
Thoracic Facet Joint Symptoms
- Pain and stiffness in the thoracic area
- Restricted range of motion
Lumbar Facet Joint Symptoms
- Pain may refer to buttock or thighs
- Pain usually does not refer below the knee
- Pain and stiffness cause walking in a forward flexed position
- Pain usually on initiation of movement (getting out of chair)
Conservative therapy- Physical Therapy, Manipulative Therapy, NSAIDS, Steroids, Bracing
- Physical therapy for correction of posture and muscle strengthening
- Osteopathic or Chiropractic manipulative therapy to correct any misalignment
- Short term bracing for aid in correcting body mechanics and alleviation of pain
- NSAIDS and oral steroids to reduce inflammation and pain
Usually done with guidance into the facet areas. Some patients do not benefit at all from these shots. Risks associated with these injections are osteoporosis, accelerated degeneration, avascular necrosis and suppression of endogenous corticosteroid production
Radiofrequency ablation (rhizolysis) is a method of destroying the nerves that innervate the facet. The long- term consequence of ongoing RF ablation has not been fully elucidated. RFA temporarily denervates the nerve that provides sensation to the facet joint but it can also denervate parts of the paraspinal muscles which can cause weakness to the paraspinal muscles.
There is a procedure available called a facetectomy when nerve roots are involved and all else fails.
Platelet-Rich-Plasma (PRP) is a concentration of autologous blood derived products that accelerate healing of injured tissue. The concentrate has increased amounts of cytokines and growth factors for tissue repair and regeneration. Since it is autologous, there are no allergic responses nor side effects from its use.
In a study comparing PRP vs corticosteroid injection for the treatment of lumbar facet syndrome the author concluded both steroid and PRP are effective however autologous PRP is a superior treatment option for longer duration efficacy.
Pain Pract 2017. Sep:17(7): 914-924 PMID 27989008
Another study to assess the therapeutic effectiveness and safety of PRP for the treatment of lumbar facet syndrome concluded “ the technique of lumbar facet syndrome treated with injection of autologous PRP is effective and safe for patients”.
(Pain Physician Nov-Dec 2016;19(8). 617-625 PMID 27906940)
In a meta-analysis of the current literature in the use of PRP in the treatment of low back pain the authors concluded “ The use of PRP in various injections such as intra- facet has yielded promising results that have been reported in the recent literature”.
(Asian Spine J 2021 Feb; 15(1) 117-126 PMID 32160728)
In a European published study, for the treatment of lumbar pain, the conclusion was PRP was similar to steroid for the treatment of lumbar pain but is a SAFER option.
(Eur Radiol 2020 Jun; 30(6): 3152-3160 PMID 320 95 875)
Currently, the US military is conducting a study on PRP . They state in their brief: This study will provide evidenced-based medicine on a new regenerative medicine treatment option that may significantly affect military personnel with low back pain. PRP may offer alternative treatment methods that may help preserve the facet joint structures and improve pain and function without causing destructive lesions or worsening degenerative joints.
Platelet-Rich-Plasma offers a safe, cost- effective low risk alternative to steroid injections for the treatment of facet syndrome. It certainly is not invasive such as radio-frequency destruction of the nerves. PRP is currently being used world -wide for this condition and currently being investigated by the US military as an alternative to the current treatment options which have long lasting side effects.
Juventix Regenerative Medical offers an FDA approved kit for the harvest of PRP. It is low cost and outcomes are reproducible. Platelet-Rich-Plasma kits are NOT all the same. Also, at Juventix, we are pleased to announce the addition of the Juventix Photo-Activativator to our line of regenerative products and services. With the Juventix Photo-Activator, there is no need to activate the PRP with the addition of additives such as thrombin or Calcium chloride. It not only activates the platelets, but adds to the products overall function by endorphin release and longer lasting release of growth factors.
Juventix Regenerative Medical. Restore, Revive, Regenerate.
Dr. Robert McGrath