FACET SYNDROME
Ross A. Hauser, M.D.
 

Chronic low back pain is the most common complaint seen at pain clinics. Typically people with chronic low back pain show degenerative changes in their vertebrae on x-rays. When the pain is primarily located at a specific attachment of two vertebrae, which is the facet joint, the person is said to have facet syndrome. The person with such a condition will typically have localized pain over the facet with bending to that side. The typical treatment for this condition is steroid injections under x-ray guidance (fluoroscopy). This approach, however, has only temporary pain reducing effects, and long term studies have shown that steroids have a weakening effect of tissues, so this is not a good long term solution.

In my opinion, a better option for people with Facet Syndrome is Prolotherapy. Facets hypertrophy (get bigger with more calcium) because they having to support extra pressure. Since the facet is where two vertebrae meet the question asked by patients and the health care providers that take care of them is "why do the facets have arthritis in them (hypertrophied)". In other words, "why is there excessive pressure on the facets?" When a patient or a doctor doesn't ask this question then why not get a steroid shot because it may decrease the pain for awhile.

Facets have extra pressure placed on them for various reasons. If the discs are dehydrated or degenerated this will cause excessive pressure on the facets. Both the facets and the discs will have excessive pressure placed on them if the supporting structures of the lower back, primarily the facet ligaments and other ligaments that connect the vertebrae together because torn, stretched, and/or weakened. This can occur when a large force is applied to the lower back by an accident, fall, sports, or high velocity manipulation. Sometimes the ligaments just 'wear out' over time because of the lifestyle of the person (lots of activities) or their weight. The ligaments have to support the lower back and if a person is carrying "a basketball in their belly" (they are obese) the pressure on the ligaments of the lower back are tremendous. People who are overweight have more chronic low back pain and I would speculate are more likely to get facet syndrome.

Prolotherapy to the facet joints, their surrounding ligaments, vertebral segments, and other structures of the lower back causes these areas to strengthen. Once the ligaments are repaired and strong, the pressure on the facets decreases. Once this happens the pain of facet syndrome is typically eliminated. Because Prolotherapy stimulates the repair of the structures that led to facet syndrome it makes the most amount of sense to have it as a first line treatment for facet syndrome. Fortunately many people who have been told they need a steroid shot or surgery for facet syndrome are saying "thanks but not thanks" and running with their pain to the Prolotherapist...

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