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Thoracic facet denervation

If you are considering having thoracic facet denervation or have a procedure planned, it is important to know all you can about it. This includes:

 

  • why you need this procedure

  • what it will be like

  • how it will affect you

  • what risks are involved

  • any alternatives.

 

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

 

 

What is the problem?

You have painful facet joints in your upper back. Pain may be felt in your upper back and may be worse when holding a fixed position for any length of time. This pain can also be worse when you extend your spine, for instance, when you straighten up from tying your shoelace. Keeping on the move usually reduces the pain. Sometimes the pain may spread to the chest wall and ribs. This is called referred pain.

Thoracic facet denervation

What is a facet joint?

Facet joints are pairs of small joints that hold the bony blocks (the vertebrae) of the spine together. As a result of injury, or simple wear and tear, these joints can become painful.

Thoracic facet denervation 2

The facet joint is a structure that does two things. It helps keep the spine straight and firm to hold the weight of your upper body. At the same time it allows limited movement so that you can bend, stretch and rotate.

Thoracic facet denervation 3

What is facet joint denervation?

Before facet denervation is considered you will have already had facet joint injections to confirm the diagnosis. These facet joint injections are also used to treat pain in that area. The injections are usually given into the lining of the joints where there is a soft membrane called synovium. The synovium can become inflamed and cause pain. This pain can lead to muscle spasm or tightness in the neck, which can produce even more pain. Sometimes the nerves supplying the joint are injected instead.

 

By targeting the painful area, facet joint injections bathe the joints in local anaesthetic and steroid solution. Only a small amount of steroid is needed and it will not cause any of the side effects sometimes associated with taking steroid tablets. Steroid is used to reduce inflammation.

 

Quite often, facet joint injections reduce pain and improve mobility for a period of weeks or months, only for the pain to return. If the pain reduction from the facet joint injections is worthwhile and useful to you, then denervation is a way of making the benefits last much longer, perhaps up to several years.

 

For denervation the nerves that send pain messages from the joints to the brain must be identified. If these nerves can be broken then the brain does not receive the pain messages. The pain is therefore reduced.

 

What has gone wrong?

You have suffered general wear and tear or damage from injury to the facet joints at the middle part of your spine. When the joints are inflamed, the nearby muscles become irritated and go into spasm or cramp. Movement is then reduced.

 

The aims

The aim of the procedure is to break the nerves that send pain messages from your facet joints to your brain. This will reduce upper back pain. If the pain usually spreads to your chest wall and ribs this should also be reduced. 

 

The benefits

Your pain should be reduced and you should be able to move around more easily. The physiotherapist will show you exercises to help prevent the problem happening again. If successful, this treatment can avoid the need for surgery.

 

Are there any alternatives?

By the time that you consider facet joint denervation you should have already had joint injections and other simple treatments. These include rest, painkilling and anti-inflammatory tablets, and physiotherapy with exercise.

 

You may also have tried a transcutaneous electrical nerve stimulation (TENS) machine for your pain. This works by sending soothing electrical pulses across the surface of the skin and along the nerve fibres. These pulses prevent pain signals reaching the brain. They also stimulate your body to produce higher levels of its own natural painkillers, called endorphins.

 

What if you do nothing?

If you do nothing there are several things that may happen:

 

  • With time and rest the inflammation and pain may settle on its own

  • The pain and difficulty in moving may remain the same

  • The pain may increase and spread to other parts of your spine

  • Your posture may get worse, making walking, sitting and even sleeping more difficult

 

Who should have it done?

The following groups of patients should have the procedure done:

 

  • Patients with upper back pain caused by painful joints

  • Patients with upper back pain who have had a good result from facet joint injections

 

Who should not have it done?

Each patient has the final decision on whether to proceed or not. If you are unhappy about the procedure for any reason you should not continue.

 

There are specific medical situations when facet joint denervations should not be done and they are as follows:

 

  • When a patient is on medication that prevents blood from clotting, such as warfarin. This would lead to more bleeding than normal. It may be possible to stop the medication a few days before the procedure. This will need to be discussed with your doctor

  • When a patient is suffering from an illness that prevents blood from clotting, such as haemophilia. This would also lead to more bleeding than normal

  • When there is infection of the skin over the site where the needle needs to be put in

  • When a patient has noticed a recent worsening of their symptoms, especially weakness and loss of bladder or bowel control

  • When a patient has metal implants in their body. Under certain circumstances this problem can be overcome, but it does need to be discussed with your doctor

  • When patients have an implanted pacemaker to control their heart rate

 

Author: Dr Sean White FRCA. Consultant in pain and anaesthesia.

© Dumas Ltd 2006

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