Once facet joint pain is identified, it can be treated with MRgFUS.

Facet Pain: Where it All Began and What Can Be Done About It

There are so many varieties of back pain causes that they could fill a catalogue: injury from an accident or sudden movement, skeletal abnormalities, degeneration of bones or joints, compression of nerves, disk problems, etc. Nerves branches from the spinal cord can radiate pain into the legs, arms, neck and head. If one part of the back hurts, a person may compensate by moving a different way which strains other muscles and compounds pain. The challenge for doctors is to unravel the source of pain. Could it be soft tissue, bones, joints, disks, nerves – or a combination of any of these? If you ever heard your grandfather moan about his “aching lumbago,” it may have been a catch-all term. Perhaps the best advice he could get was to take aspirin, apply heat or cold, and get rest.

The 20th century was a period of sorting out the origins of back pain. Some doctors started focusing on the facet (pronounced fuh-SETT) joints between each separate backbone, or vertebra. Prior to World War I, a surgeon named Joel Ernest Goldthwait was the first person to identify facet joints as a potential pain generator. Using his special interest in the mechanics of the body, he published an article in 1911 on how worn out facet joints could account for many cases of “lumbago, sciatica or paraplegia”¹. A 1927 study of 75 cadavers confirmed evidence of facet joint arthrosis (deterioration of joint cartilage leading to bone-on-bone contact) in persons over 50², and in 1933 R. K. Ghormley coined the term “facet joint syndrome” to explain how degenerating facet joints led to pressure on adjacent nerves, causing pain.³

Facet joint arthrosis doesn’t always result in pain. Many elderly people remain pain-free well into their 90s despite cartilage wearing thin. On the other hand, facet joint erosion is inevitable as we age. According to a 2009 journal article, “Eubanks et al. examined prevalence rates of facet arthrosis on 647 cadaveric lumbar spines. Fifty-seven percent of samples between 20 and 29 years of age and 93% of the samples between 40 and 49 years of age had evidence of facet arthrosis. By the age of 60, 100% of the samples had prominent facet arthrosis.”⁴

Because of all that 20th century scientific progress, the facet joints are now recognized as a common source of back pain, especially in the lumbar region. Conditions that were once vaguely labeled as “lumbago” are now more precisely identified using sophisticated imaging and other diagnostic tests. The good news is that once it’s known if there is facet joint pain, there are effective treatments ranging from simple exercise and lifestyle changes to therapies that can block pain at the point of the nerve. One new therapy in particular, MRI-guided Focused Ultrasound (MRgFUS), is a painless, noninvasive treatment for durable relief of facet joint pain by targeting the affected nerve. Contact the experts at the Sperling Medical Group for more information on MRI-guided diagnosis and treatment of facet joint pain.
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¹Goldthwait JE. The lumbosacral articulation: an explanation of many cases of lumbago, sciatica and paraplegia. Boston Med Surg J. 1911;164:365–372.
²Putti V (1927) New conceptions in the pathogenesis of sciatic pain. Lancet 2: 53-60.
³Ghormley RK. Low back pain with special reference to the articular facets, with presentation of an operative procedure. JAMA. 1933;101:773.
⁴ Binder D, Nampiaparampil D. The provocative lumbar facet joint. Curr Rev Musculoskelet Med. 2009 Mar; 2(1):15-24.