Question Title: Degenerative facets-Lumbar

Forum: Neurology Forum
Topic: Neurology - General

Posted by CCF Neuro MD on July 10, 1997 at 13:06:31:

In Reply to: Degenerative facets-Lumbar posted by Martha Garapolo on June 22, 1997 at 21:40:12:

: I am (was) a very active 43 year old female. 3 years ago I had a microdiscectomy at L4-5, and bilateral microlaminectomies at L3-4. 4-5, and 5-1. After a 4 month recovery, I gradually returned to 90% of my regular activites. 3 months ago, I had an injuryat work, (pulling and twisting). The MRI now shows that I have bulges at L3-4, 4-5, and 5-1. It also show the increase of arthritis in the lower lumbar region. I've been told I have 'really bad' facet degeneration, and that there is no relief or surgical cure. I can barely get thru a day at work as an X-ray Technologist, and tired of taking Vicodin and Lodeine to just make it thru. Now, I am in fear of losing my job, as I can not do the majority of cases and am a liability to the hospital. Even tho an injury a year ago was from catching a fainting patient, the hospital has taken away my workers comp benefits, and I can not afford to be off work.
Please tell me if I can do anything to stop or repair this destructive process that is ruining my life.

Thank you very much,
Martha Garapolo

What you describe has been called the "failed back syndrome". As many as a quarter of patients undergoing back surgery may either have no relief of pain, or a recurrence of similar or different pain after a variable period. There are a variety of causes of this syndrome, including facet joint disease which you mentioned. The majority of cases, however, do not reveal any clear cause of the pain on the MRI; these patients, on operative exploration, may show some degree of thickening or adhesion of meninges (covering of the roots and spinal cord in the spinal column). Such patients are often labelled as "arachnoiditis"(the arachnoid membrane is a component of the meninges). Facet joints are the posteriorly located joints on either side between the vertebrae. Although there is no consensus on this matter, several authorities believe that arthritis of these joints can cause back pain as well as leg pain. This can be demonstrated or proven by a therapeutic test, which is to check for relief of pain after injection of the facet joints with a local anesthetic such as lidocaine. Facet joint degeneration is not a specific disease process, but part of a more generalized diffuse arthritic process of the spine, which ensues with age.
Surgery is usually not the treatment for the failed back syndrome. Some patients benefit from epidural injection of steroid or local anesthetic. Similar injections may be tried into the facet joints, if facet joint disease is the suspected culprit. These treatments do benefit individual patients, but may not be effective in the long term.
In case you live in the Cleveland area, I recommend that you see a doctor in the Spine Center of the Cleveland Clinic. The telephone number to call for appointments is (216)444-2225
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options of your specific medical condition.

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