MRgFUS avoids three invasive facet pain procedures.
When a patient is diagnosed with facet joint disease (osteoarthritis) it can be a relief to finally have an explanation for sporadic or chronic back pain. What is not relieved, however, is the pain itself. For that, the doctor generally begins with conservative treatments. This starting approach is noninvasive, and may include physical therapy, proper exercises, oral anti-inflammatories, posture correction, heat or cold applications, and chiropractic intervention.
If these don’t bring relief, interventions become more invasive. There are three types of procedures that involve penetrating through the skin: series of injections, neurotomy (ablation), and nerve decompression surgery.
a) Pain-killing injections only bring temporary pain relief. Each injection is done under fluoroscopy (a type of x-ray) and a contrast agent to guide the needle exactly into the joint. This is usually performed without sedation, though an IV drip can administer medication to help relaxation. After the skin is numbed, the needle is inserted into the joint, and a mixture of anesthetic (numbing agent) and anti-inflammatory steroid is slowly released into the joint. If pain diminishes or completely subsides within a few days, the procedure is considered successful and may be repeated for a total of 3 injections per year.
b) Neurotomy means ablating (destroying) the nerve that transmits pain sensations to the brain, in order to block the pain messages. Another name for this is denervation. It’s an option if injections are no longer working. A needle-like probe is inserted next to the nerve, and when the needle is activated, radiofrequency waves generate intense heat that knocks out the nerve. Another approach uses a laser instead of radiofrequency waves. A successful neurotomy can bring pain relief anywhere from 9-24 months, depending on the rate of nerve regeneration.
c) If the facet joint has developed bone spurs due to the facet joint cartilage being worn away, those small projections can become large enough to compress the nerve, causing pain. Surgery to remove the spurs means an incision using a scalpel is made through the skin and muscle beneath the skin, so it is the most invasive with the longest recovery time, and the greatest risk of infection.
MRI-guided Focused Ultrasound (MRgFUS) is a new, 100% noninvasive approach to resolving facet joint pain. The principal of denervation to block pain signals is the same, but no skin needs to be pierced by a needles or probe, or cut by a scalpel so there is no risk of infection. Under MRI guidance, sonic energy (sound waves) is aimed at the targeted area from many different directions. The sound waves can’t be heard, and each wave passes harmlessly through intervening tissues until all waves converge (meet together) at the target point. When that happens, intense heat is created and the very small targeted sensory nerve is precisely destroyed. There are few to no side effects, and most patient experience a durable reduction of pain. Similar to radiofrequency neurotomy, the nerve may regenerate – but the treatment is repeatable.
The key message is that MRgFUS is completely noninvasive, so it is an alternative to injections, probe insertions, and surgeries. An additional advantage is that it can eliminate the need for medication, since many people do not wish to take pills as a way to cope with pain.
The Sperling Medical Group offers MRgFUS for facet joint pain in the cervical (neck) and lower back (lumber) regions of the spine. If you or a loved one suffers from painful osteoarthritis of the facet joints, contact the Sperling Medical Group for more information or to arrange a consultation.
- Facet Pain