Facet injuries (i.e. injuries to the facet joints of the spine) can lead to long-term, and sometimes debilitating pain. While enduring chronic facet pain can interfere with even the basic aspects of life, and can feel overwhelming to those of us unlucky enough to have sustained such an injury, it is important for patients to understand that, in many cases, there is good reason to expect that well managed medical treatment can produce enduring pain relief. Over the last several decades, the medical field has developed treatment methods which, in many cases, allow practitioners to accurately identify the exact source of a patient’s facet joint pain, and then successfully treat such pain, without resorting to long-term, chronic pain medication.
Our personal injury lawyers are experts at handling facet injury cases. At its most basic level personal injury law is about fairness. People who suffer from chronic facet injury pain following a car accident are all too often ignored and even mistreated by the insurance companies that are supposed to provide aid. Our lawyers work to make sure those of us who suffer chronic facet mediated pain as a result of someone else’s wrongdoing receive fair treatment under the law.
Anatomy of the facet joints
The vertebral column extends from the base of the skull all the way down through the back to the sacrum. The vertebral column is a complex system of bones linked by joints and stabilized by strong ligaments which run along its length. The spine supports the body, protects the spinal cord and nerves, and allows for movement. The major structural support in the spine is the column of vertebral bones separated from one another by the intervertebral discs. In the rear of each vertebral level are two facet joints, one on each side. The facets connect one vertebra to another while allowing for smooth motion. All of these structural components have nerve supplies, and injury to any component can cause pain.
Mechanism of Injury
The most typical facet injury arises from a motor vehicle collision. The force of an automobile collision can result in abnormal motion of the structures within the spine. Such abnormal movement is beyond normal biomechanical limits and has the potential to injure structures including the facets, disks, and ligaments. Facet joints can undergo a pinching motion, with compression in the rear and distraction (pulling apart) in the front, usually coupled with shear. The anulus (outer lining) of the disk and longitudinal ligaments can be disrupted by the same abnormal motion.
Facet injuries can include bony impingement; capsular strains and tears; synovial pinching; and direct trauma injury resulting in contusion, intra-articular hemorrhage, and damage to subchondral bone. Disk injuries can include strains or avulsion of the front portion of the disk anulus, tearing of the rear portion of the anulus, and disk herniation. Each of these structural injuries has the potential to cause both acute and chronic pain.
Causes of Chronic Facet Pain
Facet joint pain is the most common cause of chronic pain following a motor vehicle collision. Such pain may occur alone or in conjunction with disc pain. It is not uncommon for a patient to experience injury to the facet joints on multiple levels. One cannot determine if a facet joint is the source of pain by looking at it on an X-ray or MRI scan. The only way to tell if the facet is the source of pain is to conduct a diagnostic test. One of the most common diagnostic tests is known as a “medial branch block (MBB).”
Injury to the intervertebral disc can also cause chronic pain. A person with disc pain can also have pain from a facet joint. The outer wall of the disc is known as the annulus. The annulus can be pinched or torn during a whiplash and cause pain that is communicated to the brain via peripheral nerve endings located in the annulus. The disc usually heals, but in some people the disc does not heal. A disc that does not heal may get weaker and cause pain even during normal activities. Disc injuries can also lead to pain when they bulge or herniate and push on the spinal cord or other spinal nerves.
Potential treatment for chronic facet pain runs the full gamut from the most conservative care of short rest, heat, and pain alleviation to extensive surgery. For the most part, the therapy chosen depends on the pathology being treated.
Physical therapy is often the first treatment prescribed for a patient with chronic facet pain. Effective rehabilitation requires strengthening exercises and training in body mechanics. Exercise alone is rarely curative, and can sometimes actually lead to increased pain.
There is evidence that exercise directed toward strengthening the muscles of the neck and back can reduce pain and improve function in some patients with chronic pain. For reduced pain to endure, the patient must continue exercises indefinitely. Strength training and endurance training have been shown to be more helpful than stretching and aerobic training. Intensive exercises are more helpful than light exercises but not necessarily more effective than ordinary activity. There is some evidence that a multidisciplinary program can reduce pain, improve range of motion, improve function, and decrease disability. Rehabilitation programs should be directed toward strengthening the muscles that are usually weak.
Level I medical evidence supports radio-frequency neurotomy (RFN) as an effective treatment for some types of chronic facet pain. RFN is a method that deadens the peripheral, medial branch nerves responsible for conducting pain from the facet joint to the brain. The best indication for RFN is significant pain relief following controlled anesthetic blocks of the medial branches of the nerve supply to a specific facet joint. Complete pain relief can be achieved in many patients with pure facet joint pain. Patients with facet mediated headache can also obtain dramatic and sometimes complete relief. Some patients may have other pain generators in addition to the facet joints, such as pain emanating from and intervertebral disc. Relief from RFN has been shown to last a median of between 270 and 400 days, after which pain recurs because the nerves regenerate. Repeat RFN is usually effective in relieving recurrent pain.
Surgical intervention may be considered for patients with severe pain, significant impairment, who have not improved sufficiently with high-quality nonsurgical care. Surgery may also be indicated where there is damage to the discs, or other physical components, or where there is pressure being placed on the spinal cord or other nerves.