DR. ALEX VALADKA: We're here to talk about facet syndrome. Now, what are the facets? They are the joints in the back of your spine. Let me show you on the model here. If this person is facing away from us looking at the back and this is the middle of the spine right here, these right here are joints. And when a person moves or twists, there are movements at these areas too. These are joints. They're just the same way that your shoulder and your knee and your hip are all joints, and for some reason they can be the source of pain. Well, the most common reason is just old age wear and tear. The joint lining can wear out, so the bones tend to rub off against each other and there's less of a cushion in there. In other cases, there's a small nerve that comes off of your spinal cord that could run to the back and give feeling to those joints. That could also be the source of pain. Typical symptoms might include pain in your back that's usually worse with some sort of motion, especially twisting or bending from side to side or getting into a chair, trying to rise from a chair once you bend your spine front to back. The pain could be in your lower back and even goes down to your buttocks or even your upper thighs. Now, it's a very difficult thing to diagnose because it overlaps with a lot of other conditions. Oftentimes, physicians will order X-rays or MRI scans or CT scans which often will show arthritis and degenerative change in those facet joints. To really help make a diagnosis, a physician may order a facet block in which, under fluoroscopic guidance, some anesthetic is injected into the nerves that go to that joint. And if that causes a significant decrease in pain, that's pretty good evidence that the source of pain is the facet joint. If it looks like that's the case, you can try some what we call conservative measures beginning with posture modification, just like your teacher told you in second grade, to sit up straight and don't slouch. You can try to cut back on your activities a little bit. Nonsteroidal medications like Motrin or ibuprofen is often very helpful. And even exercise to build up the range of motion, the flexibility and the strength of the muscles in your back because that can take some of the pressure off the facets. If all those things fail or if the pain recurs, one of the best treatments is what's called the radio frequency block in which the nerves that go to that facet joints are actually destroyed with a radio frequency type of lesion generator. And again, like all these things, if your patients are chosen well, you can get a lot of relief from an intervention like that.
