I found this article in PainMedicineNews. It sets out a finessing of the surgical response to chronic – and it must be chronic to be this bad, Posterior Facet Syndrome (PFS). Now, I’ve blogged about PFS before and so you’ll all know how important it is and if you are unsure have a look at what Dr Bennett has to say about PFS in this article.
Have a read and then see why we tell people to get some early care and so avoid this stuff as it just can’t be good for you!
“For Facet Joint Pain, Minimally Invasive Surgery A Good Fit
In pilot study, 30-minute surgery reduces pain, opioid use; multicenter trial to followGabriel Miller
A minimally invasive approach for facet arthrodesis (artificial induction of joint ossification between two bones via surgery – my note) reduces pain as well as chronic opioid use in back pain patients, according to a new study. The procedure — originally developed and used by orthopaedic surgeons and neurosurgeons — also may be performed safely by interventional pain physicians, the study demonstrated.
Although arthrodesis of the facet joints is not a new procedure, experts say a minimally invasive approach — which can be performed by a number of specialties — is novel.…Like an open surgical approach, the concept behind the minimally invasive arthrodesis is to fuse the facet joint by drilling a hole between the joint walls and tamping an allograft bone dowel into the joint, separating the joint surfaces, locking the facet joint into place and providing a minimal amount of stability. Facet joint disease most often results from degeneration of the cartilage within the facet joint; the joint then becomes unstable and shifts around loosely, causing painful bone-to-bone contact.“ The premise is if you can eliminate the motion that you have between these facet joints, then you can take away the pain,” said Dr. Guiot.
Daniel Bennett, MD, medical director of Integrative Treatment Centers in Denver, and the lead investigator of the pilot study presented at the AAPM meeting [said]: “Because the No. 1 cause of sustained low back pain is joint-related, this procedure is a new tool in the interventional pain specialists’ tool belt.”
The study included 28 prospectively enrolled patients with facet-mediated low back pain, (so, PFS in other words) that was confirmed by intraarticular facet injection. Patients also were required to have previous radiofrequency ablation (RFA) with a return of pain. “We wanted to start with a population that had experienced the current gold standard of care and [had] at least gone through all of the invasive treatments short of surgery,” Dr. Bennett said.During the procedure, a minimally invasive (!), stab-wound incision is made and Steinman pins are placed between the facet walls. A drill guide is inserted using a spatula and the pins are removed; using the guide, a cortical reamer then bores a Morse taper-shaped canal of bleeding bone, into which the bone allograft is placed. (Minimally invasive, mind!)
The primary end points in the study were pain measured on a 100-point visual analog scale and function measured with the Oswestry Disability Index (ODI), each of which was measured at four, 12 and 52 weeks postoperatively. After complete follow-up, average pain scores decreased from 79 to 23 and functional disability, as measured by the ODI, improved from 33.46 to 8.32 (SD, 5.17).
Narcotic use also was measured before and after surgery, with morphine equivalents as high as 510 mg per day among patients. However, after 12 months, only four patients remained on opioids,
Dr. Bennett said:
“There was a big difference [in opioid use] and at the end of the day, when you look at that with the ODI data, there is a significant improvement in function,” he said.“Pain management specialists inject facet joints all day long, so they are extremely accustomed to getting into that joint—in fact, much more accustomed than any surgeon would be,” said Dr. Guiot. “Once you are in the joint and you can access that space, that’s the toughest part of the procedure [and] the remaining portion is actually very simple.”
An additional key benefit, Dr. Guiot said, is that a minimally invasive (!) approach, which doesn’t damage or significantly alter surrounding tissue, doesn’t preclude any larger reconstruction procedures at a later date. “The most beneficial aspect is that this really doesn’t burn any bridges,” he said.
Dr. Bennett believes that the diagnostic approach used prior to minimally invasive (!) arthrodesis represents a shift toward treating pain at the source, rather than blunting nerves through ablation or opioids.
“One important thing to point out: This technique only treats the joint,” Dr. Bennett said. Arthodesis may prove more durable than RFA, but in order for it to work effectively physicians have to know precisely where the pain is originating.
“What I’m advocating based on the data is intraarticular facet injections that confirm the pain generator as the joints, not ligament or muscular structures,” he said. “Then you know what you should expect as an outcome when you fuse those painful joints.”
So stapling the joints together reduces the pain. Now this is laudable but no one should get to the point that they need their joints, which are designed to move, to be clamped together. Please get some care into those joints before you need ablating (!), opiods which I’m sure my mother warned me about or a minimally invasive (!) arthrodesis.
