Spondylosis? Arthritis? Degenerative joint disease? Whatever, it hurts, just fix it bro.
In a nutshell, a joint exists anywhere that two bones touch. We all get a little wear and tear on our joints over time as they rub together. As those damaged joints rub together, they send smoke signals to your brain telling us that something is wrong (which we interpret as pain.) Picture opening and closing a door thousands of times every day for 60 years. After that much use, those door hinges are not going to function as well as they did when they were first installed. So, what can we do? We can tighten them, we can oil them, and in some cases, we can replace them. We can also medicate ourselves to the point where we don’t care that they are not functioning properly, but I don’t recommend this approach.
The primary pain-generating joints of the spine are called facets, also known as zygapophyseal joints (lol.. yeah, we’ll just call them facets.) You can treat these joints with physical therapy, to strengthen the muscles around the joints (similar to tightening the screws.) If that doesn’t work, you can inject medication into them (similar to oiling the hinges.) Still hurting? I guess it’s time for surgery. You can fuse the joints, or you can replace them altogether. If there is no movement across the joint, and nothing is rubbing together, then you won’t get those smoke signals sent up to your brain. This is why facet fusion should work, in theory. There is also an FDA approved facet joint replacement surgery, but the indication is fairly narrow (meaning there is pretty strict inclusion criteria for successful outcomes.) So surgery is our last resort, but even that is not a sure thing.
What if we could stop the smoke signals? What if we could intercept the pain signals before they get transmitted to your brain? Sounds like mad science, but this is a standard pain management technique. The procedure to interrupt this pathway is known as a medial branch rhizotomy. Some other names for this procedure are neurotomy or ablation. The medial branch is a small nerve that transmits pain signals from the facet joint to the spinal cord, and ultimately up to your brain. Pain doctors are able to locate this nerve using fluoroscopy, and create a small lesion across a portion of it. This would effectively disrupt the pain-pathway, and the signals would never register in your brain. Sounds great, right? Gimme a call, I’ll sign you up.
There are some caveats, proviso, stipulations, terms, and conditions. Prior to indiscriminately just “burning nerves” we need identify which joints are causing your problem. Physical examination and your MRI are used to pick the joints. Now that we know which joints we want to treat, we have to confirm that these are your pain-generators. We block these joints by injecting a drop of anesthetic onto their medial branch nerves. Then you get up, move around, and tell us how you feel. If you feel good, that means we blocked the right joints. Next we need another block later to confirm (yes, a second additional injection, on a separate occasion, to decrease the likelihood of a false-positive.) After we jumped through these hoops, crossed our I’s and dotted our T’s, we are ready to cook some nerves. How would you like those prepared? Medium-rare? Warm pink center? I got you bro.
