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acet joints are structures that have contact between 2 superimposed vertebrae, restrict certain movements and prevent the vertebrae from running forward.

It has been shown that in the facet joints that cause problems, the pain nerves are activated. The activation of these nerves causes pain and the release of substances involved in neurogenic inflammation.

So, this medical procedure involves injecting a product, usually a steroidal anti-inflammatory drug-derived from cortisone-and/or an anaesthetic in the facet joint.

Cortisone derivatives have a very powerful anti-inflammatory effect, although their risks and contraindications prevent them from being administered continuously via IV. In addition, when administered via IV, only the part of the administered dose that through the blood reaches the inflamed territories has an effect. To increase the effectiveness of its anti-inflammatory effect and reduce its risks, in the facet infiltration the steroids are placed in the facet joint so that they have a powerful local effect and fewer side effects. This would neutralize the effect of the substances released by the nerves of pain and reduce inflammation.

What is the role of anaesthetics?

In the same way, the injection of local anaesthetics directly into the joint would allow a greater percentage of the administered dose to have an effect. Its objective is to inhibit the nerves of pain.

However, although the origin of back pain is due to an alteration of the facet joint, if the pain is sustained for a sufficiently long period of time, neural mechanisms are activated that keep it independent of the cause that caused it initially, or even when it has disappeared.

Facet joint injections are often combined with a caudal epidural injection for best pain relief.

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he nerve roots are arranged symmetrically on both sides and exit the spinal canal through small openings located between two adjacent vertebral bodies. In this case, one or several of these nerve roots are affected by an intervertebral disc (disc herniation or disc protrusion), by arthrosis of the small vertebral joints (facet joints), as a consequence of a generalized narrowing of the spinal duct or due to a narrowing of the nerve outlet opening. The goal of infiltration is to mitigate pain through a localized injection of medications. In this way, it is the reintroduction of support measures such as physiotherapy.

Infiltration Process of the Lumbar Nerve Root

Infiltration is carried out with the help of computed tomography (CT). In total, you must remain in the upside-down position for about 15 minutes for the planning and infiltration itself. After a brief consultation, the radiologist plans the optimal access route to the nerve root based on some CT images. Once the ideal point is located, the skin is numbed by a fine needle (local anaesthesia). The needle is then introduced in stages, anaesthetizing locally several times until the tip of the needle is close to the nerve root.

This procedure may be combined with a caudal epidural injection for best effect.

During the process, the position of the needle is controlled by some CT images or fluoroscopy (x-ray). Once the needle is located near the nerve root, it is injected a small amount of contrast substance, which should extend along the nerve root. At this time, you may feel a cramping pain in your leg. In case this pain is very intense, the doctor will wait a moment and then inject more slowly. Then a small amount of cortisone and a local anaesthetic are injected through the same needle. After a few minutes, the local anaesthetic should achieve a noticeable relief of pain.

Cortisone prevents local inflammation

When the effect of local anaesthesia disappears (a few hours), you may again partially perceive your known pain in the leg. Cortisone begins to make a more intense effect after 1 to 3 days. It is uncommon that pain relief does not occur.

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n epidural injection is usually highly effective in more recent conditions and has a lower success rate when the problem is longstanding. In a few cases, an epidural injection may offer little or no alleviation of pain. Each patient is different; however, there are times when the injection can be repeated after a few weeks or months to receive the utmost benefit from the medication. If epidural injections do not help to relieve pain, we will probably recommend another therapy. The reasons why an injection may not work is if it was incorrectly injected. Do not have a spinal injection without imaging as there is a high rate of miss without imaging. Our experts always perform spinal injections under image guidance using low radiation XRAY or CT Scan.

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Have you ever been told about the core muscles and its importance on back pain? In order to explain why this musculature is a determining factor in maintaining the stability and health of our back, it is necessary to understand the process; we will differentiate the muscles into two types:

Mobilizers: Thanks to their characteristics, they have the main function of producing movement. An example can be the lumbar square also known as quadratus lumborum.

Stabilizers: They have the main function of controlling the movement of the joints, giving them stability. Although there are also important shallower stabilizing muscles, these are the types of muscles commonly referred to when talking about deep musculature. An example is the multifidus.

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ore than 10 years have passed since total disc replacement (TDR) was introduced for the first time to the world market for the surgical management of degenerative disc disease (DDD). It seems like the right time to sum up the relevant results in order to understand where TDR stands on now, and is heading forward to.

The pathogenesis of DDD has been currently settled, but diagnosis and managements are still controversial. Fusion is recognized as golden standard of surgical managements but has various kinds of shortcomings. Lately, TDR has been expected to replace fusion surgery. A great deal of TDR reports has come out. Among them, more than 5-year follow-up prospective randomised controlled studies including USA IDE trials were expected to elucidate whether for TDR to have therapeutic benefit compared to fusion.

The results of these studies revealed that TDR was not inferior to fusion. Most of clinical studies dealing with TDR revealed that there was no strong evidence for preventive effect of TDR against symptomatic degenerative changes of adjacent segment disease. TDR does not have shortcomings associated with fusion. However, it has a potentiality of the new complications to occur, which surgeons have never experienced in fusion surgeries. Consequently, longer follow-up should be necessary as yet to confirm the maintenance of improved surgical outcome and to observe any very late complications.

TDR still may get a chance to establish itself as a substitute of fusion both nominally and virtually if it eases the concerns listed above.