Facet Joint Pain

Recently Spine-Health.com featured the blog post below by Dr. Stephen Hochschuler, co-founder and orthopedic spine surgeon at Texas Back Institute.

Stephen_Hochschuler_MD

Facet Joint Pain after Spine Surgery

The facet joints are two small joints in the back of the spine, on the left and right sides, at each level. These joints work with the discs to provide support and motion to the spine.

There are several ways in which these joints can produce pain:

  • Nerves in the joints can be compressed and/or irritated by inflammatory agents
  • Facet joints can degenerate, become arthritic, and produce pain by forming osteophytes (bone spurs) which compress nerves passing into the legs.

As with many joints, degenerative changes can occur in the facets, which can become painful. Degeneration is likely to occur in the spine as a part of the aging process, regardless if surgery has been performed or not. However, some types of spine surgery may alter load or movement patterns of the spine, which in turn can affect the facet joints.

Causes of Post-operative Facet Joint Pain

Facet joints may be related to pain after spine surgery in several ways:

  • These joints may continue to degenerate after a surgical procedure to treat a herniated disc or compressed nerve roots at the same spinal level
  • Surgery may change the loading or movement patterns of these joints, leading to degeneration and pain.

Following a spine fusion at one spinal level, motion of the level(s) next to it may be altered to compensate for changes the fusion caused. This change in motion pattern may cause facets at the adjacent segment(s) to degenerate and become painful.

Facet joint pain is difficult to identify without injections into these joints. In back pain patients, pain may arise from more than one source within the spine. While surgery may address one problem, existing facet joint pain may not have been recognized prior to the spine surgery, and therefore not addressed.

Treatment Options for Facet Joint Pain

Treatment of facet joint pain may include one or a combination of the following:

  • Physical therapy
  • Medication
  • Chiropractic care/manual manipulation

If these treatments do not provide relief, then more invasive procedures are an option, including:

Treatment Considerations

The most important aspect of pre-operative planning for facet joint pain is the diagnosis. As with real estate investments, where the focus is on “Location, Location, Location,” for spine surgery the name of the game is “Diagnosis, Diagnosis, Diagnosis.”

It is therefore stressed that before any spinal surgical intervention is considered, a thorough diagnostic work up is needed to determine any and ALL causes of the back pain one is addressing.

This is part of the reason that a preoperative discussion and a patient education program is necessary. This process will afford the patient a full understanding as to what is known and unknown in each individual case and what expectations can be set in accordance with all treatment variables.

Failed Back Surgery Syndrome

The post below was featured on Spine-Health.com and was contributed by Dr. Stephen Hochschuler, co-founder and orthopedic spine surgeon at Texas Back Institute.

Failed Back Surgery Syndrome (FBSS) refers to chronic back or neck pain, with or without extremity pain, which occurs if spine surgery does not achieve the desired result. Contributing factors include recurrent disc herniation, compressed nerves, altered joint mobility, scar tissue, muscle deconditioning and degeneration of facet or sacroiliac joints.

The problem of failed spine surgery has long been a perplexing and intriguing problem my colleagues and I have tried to accurately analyze and pro-actively prevent. My goal as a spine surgeon is to help treat patients with pain stemming from their spine. Many times I am able to treat patients with nonsurgical treatment options, such as physical therapy or medication, and they do very well. In some instances though, this treatment plan does not provide patients with the pain relief needed so we have to pursue more aggressive treatment options including surgery.

I always consider surgery to be a last option approach to spine care and therefore am very careful to make sure my patients are in the best position to have a successful surgery, in turn minimizing the chances of FBSS. Through experience I know there are several factors that have shown to contribute to failed back surgery syndrome, and therefore I follow the protocol below to make sure my patients are set up for their best outcomes:

  1. Before the surgery:
    • Always treat patients conservatively (non-operatively) first
    • Make sure the patient is correctly diagnosed – meaning that the cause of the patient’s pain has been accurately identified
    • Provide a thorough pre-operative evaluation
    • Make sure the surgery is the right one for the patient
    • Appropriately educate and set expectations for the patient, including pre-operative psychological evaluations.
  2. During the surgery:
    • Take all proper precautions to minimize intra-operative issues.
  3. After the surgery:
    • Keep a close eye on post-operative recovery
    • Work closely with the patients’ interdisciplinary care team.

If you are considering spine surgery, it is important to sit down with your surgeon and determine how he actively attempts to minimize the risk for failed back surgery syndrome. If you have been diagnosed with FBSS, it is not necessarily the end of the road. There exist many alternative treatment approaches to deal with this syndrome, but once again one size does not fit all. It is important to find a surgeon who has experience in treating patients with FBSS and can offer you multiple treatment options.

Dr. Scott Blumenthal was the first Orthopedic Spine Surgeon in the US to perform an Artificial Disc Replacement (ADR) surgery. This life changing surgery has now helped over 1,400 Texas Back Institute patients. Recently SpineUniverse.com featured the blog post below about the choosing the right spine surgeon for you.

Choosing the Spine Surgeon Who Is Right for You

Patients often wonder how to choose a spine surgeon to perform their total disc replacement.

The easy answer to this question is simple:  carefully.

The longer answer to this question is:  do your research, both on your surgeon and on the procedure.

Tips for Choosing a Spine Surgeon for Disc Replacement
While thousands of surgeons have been trained in disc replacement techniques, very few have adopted it into their clinical practice with any regularity.

Certainly, the bare minimum requirements for choosing a surgeon would be to ensure he/she is a board certified or board eligible orthopedic or neurosurgical spine surgeon.  “Board certified” means that the doctor has gone through a rigorous testing and peer evaluation process by a specialized medical board.

You can ask your doctor if he/she is board certified, or you can research it online.

Some tips to get a better feel for the expertise of the surgeon are:

  • Ask how long he/she has been performing disc replacement surgery and with what frequency they do this procedure.
  • Make sure your surgeon performs many types of surgery and can tailor your treatment to be most appropriate for your condition. Not every patient is best served with a spinal fusion, nor is every patient best served with disc replacement.
  • Make sure you have open communication with your physician.
  • Make sure you trust and have confidence in your surgeon’s abilities.
  • Look at the surgeon’s academic credentials or published papers.  Find out what they have written on disc replacement and if they are leaders in this specialized area of spine care.

A warning to patients:  Don’t depend on fancy advertising or marketing when choosing a surgeon.  Use all your resources when making a decision this critical. The Internet, medical directories and societies, as well as your regular physician can all be great resources in helping you decide which surgeon to go to.

There are also additional resources such as patient chat rooms and blogs where you can read about other patients’ experiences with surgeons.

Choosing a spine surgeon is a very important decision, and the more facts you can get, the better. Luckily, there are many resources to help you find a spine surgeon who is right for you.

Mistakes Men Make Concerning their Back Health

Men taking charge is nothing new in most situations.  At work, at the gym, on the sports field or even when a little spider invades the kitchen.  When it comes to their back health and safety men can be known for being a little lackadaisical.

Dr. Ted Belanger, an orthopedic spine surgeon at Texas Back Institute in Rockwall shares 5 mistakes men can make when it comes to their spine health.

 

1)       They don’t exercise their back.  Guys go to the gym and exercise their “glamour muscles” to get strong and look trim, but they only rarely do any exercises to strengthen their back.  Your back is made of the same tissues as your arms and legs, and responds to exercise in much the same way.  The old adage that it’s dangerous to exercise or use your back for strenuous activity is a myth.  You can strengthen it just the same as you strengthen your biceps—with repetitive range of motion against resistance until you reach muscle fatigue.

2)       They don’t do enough research.  Very often evaluation of back problems is sought without any careful research to determine who might be the best person to see.  There are big differences in the training, background, certification and experience of the various practitioners available to assess a patient with a complaint about their back or spine.  The list includes chiropractors, primary care physicians, physiatrists, pain management doctors, orthopaedic surgeons, neurosurgeons and orthopaedic spine surgeons.  Among these, no specialist has more training and experience assessing and treating musculoskeletal conditions than an orthopaedic surgeon.  Most of the others on the list either have very little musculoskeletal training (neurosurgeon) or have no experience at all in the surgical treatment of spine conditions (all the rest).  An orthopaedic spine surgeon is in the best position to diagnose and treat a patient with a back/spine problem, whether or not they need surgery.

3)       They don’t ask enough questions.  Patients often present for a second opinion to our clinic.  A common element of their frustration and sometimes confusion is a lack of understanding of their problem.  This can be avoided by insisting your questions be answered the first time around.  Bringing a list of standard questions is a great way to make sure you are communicating well with your doctor.  Good questions are:  What is my diagnosis?  What will happen if I don’t do anything about it?  What are my options to treat it and what can I expect from the treatment?  How does the treatment work, exactly?

4)       They don’t recognize the difference between amateur and expert advice.  People often put as much weight on their neighbor or friend’s back advice as they do their doctor. While good-intentioned, the patient should at least recognize that their doctor, particularly if they are an orthopaedic spine surgeon or neurosurgeon, has much more insight and understanding about the diagnosis and treatment options.  A common comment made by patients and their friends and family is “back surgery doesn’t work”.  But that’s a drastic generalization that simply isn’t true.  There are many different kinds of back surgery (discectomy, fusion, disc replacement, decompression, etc.) and many different reasons to undergo back surgery (degenerative conditions, fractures, trauma, scoliosis, deformity, tumor, infection).  Whether or not surgery is successful depends largely on the diagnosis you are treating, the details of the workup, the execution of the surgery, the choice of surgical technique, and the alignment of the expectations of the patient with what the surgery can accomplish.  Orthopaedic Spine Surgeons know this better than anyone else.

5)       They too often think their back problem is hopeless and they just need to “live with it”.  Patients are often afraid to seek advice about surgery because they are afraid.  They should think of the office visit the way the doctor does: a consultation to answer questions and provide information.  The decision about what treatment to participate in always rests with the patient.  If you are still not sure after visiting with a doctor, feel free to do more research, ask more questions, and seek more advice from experts.  Sometimes second or even third opinions are necessary to come to a decision about how to proceed.

If you or someone you know has fallen victim to one of these mistakes, it’s not too late.  Give us a call today and we will talk to you about your situation and help you figure out what the best treatments are for you!

Now that the school year is off to a good start and football season is in full swing many may think the safest place for athletes is on the sidelines, however, studies show this isn’t necessarily the safest place for athletes anymore.  In the 29th Annual CATASTROPHIC SPORTS INJURY RESEARCH report high school cheerleading is accounted for 64.8% of injuries to female athletes and 70.6% at the college level.  Many attribute this high injury rate with an increase in gymnastic type stunts.  Though injuries may never be completely preventable, there are some tips cheerleaders can follow-up help decrease the likelihood of injury.

According to The University of North Caroline National Center for Catastrophic Sport Injury Research the following are a list of sample guidelines that may help prevent cheerleading injuries:

1. Cheerleaders should have medical examinations before they are allowed to participate.  This would include a complete medical history.

2. Cheerleaders should be trained by a qualified coach with training in gymnastics and partner stunting. This person should also be trained in the proper methods for spotting and other safety factors.

3. Cheerleaders should be exposed to proper conditioning programs and trained in proper spotting techniques.

4. Cheerleaders should receive proper training before attempting gymnastic and partner type stunts and should not attempt stunts they are not capable of completing.  A qualification system demonstrating mastery of stunts is recommended.

5. Coaches should supervise all practice sessions in a safe facility.

6. Mini-trampolines and flips or falls off of pyramids and shoulders should be prohibited.

7. Pyramids over two high should not be performed.  Two high pyramids should not be performed without mats and other safety precautions.

8. If it is not possible to have a physician or certified athletic trainer at games and practice sessions, emergency procedures must be provided.  The emergency procedure should be in writing and available to all staff and athletes.

9. There should be continued research concerning safety in cheerleading.

10. Cheerleading coaches should follow the concussion policy and guidelines published by the NFHS (National Federation of State High School Associations).

11. Cheerleading coaches should have some type of safety certification.

12. The NFHS should make cheerleading a sport, which will place cheerleading under the same restrictions and safety rules as all other high school sports (physical exams, qualified coaches, safe facility, athletic trainers, practice limits, and starting and ending dates for practice and games or competitions). The NCAA should follow this same recommendation.

A cheerleader has been defined as someone who calls for and directs organized cheering, but more recently cheerleading involves much more than this.  It’s important everyone involved in cheerleading is taking an active approach to keeping our cheerleaders safe.

Do you love cheerleading?  Tell us what’s your favorite thing about cheerleading below!

1st US Service Member to Receive Artificial Disc Celebrates 8 Years Pain-Free

He was a U.S. Marine on Active Duty, planning a career as a Naval Aviator, when a herniated disc stopped everything. Alex Fender saw all his plans postponed, then stopped indefinitely, as physicians repeatedly told him that he would be ‘medically retired’ from the Corps at the age of 21. It was a prediction he refused to accept.

In 2004, Fender met Dr. Scott Blumenthal, a spine surgeon at Texas Back Institute in Plano. After the initial exam, Dr. Blumenthal suggested an artificial disc, which was a new procedure at the time.

Artificial Disc Replacement had just recently been FDA approved back then,” says Dr. Blumenthal, “I had exceptional outcomes since performing the first disc replacement in the US and I knew Alex would be a good candidate for this procedure.”

Fender was up and walking pain-free hours after his surgery. He had no complications, served four more years on Active Duty, and was honorably discharged in 2008.

Today, Fender is a successful entrepreneur in Dallas. He now serves as CEO of Funnel Science, an internet marketing and SEO agency.

“Staying healthy is objective number one,” says Fender. “You can’t get on with your life if you’re not able to get up and go to work. Texas Back Institute gave me that opportunity, and I’m glad to be an example of how well this surgery works.”

Professional bass fisherman, Ryan Lovelace gets back to fishing

As a professional bass fisherman, Ryan’s pain was exacerbated by his participation in several fishing tournaments every year. In order to win or place in these professional bass fishing tournaments, the angler must catch as many bass as possible with the idea being that the final fish weight of his top 5 fish are compared to the other participants.

The fishing tournament typically lasts for two days and the more fish that are caught, the higher probability of getting 5 huge ones. This requires lots of casts. How many? “I typically cast 3,000 to 3,500 casts each day of a tournament,” Lovelace said.
Standing on his feet for about 8 hours and casting 3,000 times a day during a tournament took its toll on Ryan’s injured back. Over time, it wore down his L5 vertebra and Dr. Richard Guyer at Texas Back Institute recommended a microdiscectomy.
After this procedure was completed, Ryan spent less than 24 hours in the hospital for recovery and was sent home for rest and further rehabilitation. A short while after his operation, Ryan is getting back to his top fishing form. He hopes to be completely recovered and able to compete in the 2013 pro bass fishing season.

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