Facet Joint Injury Overview

The facet joints are the connections between the vertebrae of the spine. The nerve roots pass through these joints to go from the spinal cord to the arms, legs and other parts of the body.

These joints also allow the spine to bend and twist, and they keep the back from slipping too far forward or twisting without limits. Like the knee joint, they have cartilage to allow smooth movement where two bones meet. The joints are lined with cartilage and have lubricating joint fluid. The facet joints of the lumbar (lower back) spine bear a large amount of stress and weight, making them vulnerable to degeneration and injury.

Facet Joint Injury from a Car Accident

The most typical facet injury arises from a motor vehicle collision. The force of an automobile collision can result in abnormal motion of the structures within the spine. Such abnormal movement is beyond normal bio-mechanical limits and has the potential to injure structures including the facets, disks, and ligaments. Facet joints can undergo a pinching motion, with compression in the rear and distraction (pulling apart) in the front, usually coupled with shear. The anulus (outer lining) of the disk and longitudinal ligaments can be disrupted by the same abnormal motion.

Facet injuries can include bony impingement; capsular strains and tears; synovial pinching; and direct trauma injury resulting in contusion, intra-articular hemorrhage, and damage to sub-chondral bone. Disk injuries can include strains or avulsion of the front portion of the disk anulus, tearing of the rear portion of the anulus, and disk herniation. Each of these structural injuries has the potential to cause both acute and chronic pain.

Causes of Chronic Facet Pain Following an Accident

Facet joint pain is the most common cause of long term pain following a car accident. Such pain may occur alone or in conjunction with associated disc pain. Unfortunately, it is not uncommon for an individual to experience injury to the facet joints on multiple levels. One cannot determine if a facet joint is the source of pain by looking at it on an X-ray or MRI scan. The only way to tell if the facet is the source of pain is to conduct a diagnostic test. One of the most common diagnostic tests is known as a “medial branch block (MBB).”

Injury to the intervertebral disc can also cause chronic or long term pain. A person with disc pain can also have pain from a facet joint. The outer wall of the disc is known as the annulus. The annulus can be pinched or torn during an auto accident and cause pain that is communicated to the brain via peripheral nerve endings located in the annulus. The disc usually heals, but in some people the disc does not heal. A disc that does not heal may get weaker and cause pain even during normal activities. Disc injuries can also lead to pain when they bulge or herniate and push on the spinal cord or other spinal nerves. ( See Cervical, Thoracic and Lumbar Disk Herniation )

Facet Joint Injury Symptoms Vary

Facet joint pain produces different symptoms based on the spinal region affected.

Cervical facet joint syndrome
Facet joint damage in the neck can produce neck and shoulder pain that can restrict your range of motion, making it difficult to rotate your head comfortably. Facet joint syndrome in the cervical spine may also cause headaches.

Thoracic facet joint syndrome
Thoracic facet joint damage can cause pain in your mid-back, and you may find your range of motion restricted to the point where you find it necessary to turn your entire body to look over to the right or left.

Lumbar facet joint syndrome
Low back pain is commonly caused by facet joint damage. You may feel pain in the lower back and sometimes in the buttocks and or thighs (the pain usually does not go below the knee). Inflammation of these joints can cause stiffness and difficulty standing up straight and getting up out of a chair. Pain with initiating motion is the most common symptom. The condition may cause you to walk in a hunched over position.

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Treatments for Facet Joint Pain

Injection therapy

Treatment injections contain numbing medications that work on the nerves around the facet joint, reducing their ability to carry pain signals to the brain. Injections also contain steroids, which decrease the inflammatory reactions in the facet joint, reducing the pain.

Common injection techniques that help target facet joint pain, include:

• Facet joint injections. These injections treat pain stemming from a specific facet joint. The injection is typically delivered into the capsule that surrounds the facet.

• Medial branch blocks. These nerve block injections deposit medication around the medial branches (pain transmitting branches) of spinal nerves.

• Radiofrequency ablation (RFA). This injection treatment relieves pain by inducing a heat lesion on the pain-transmitting nerve near the facet. The lesion prevents the nerve from sending pain signals to the brain. An RFA is usually considered when an accurate diagnosis of facet joint pain is made through the diagnostic double block injection technique.

Once your doctor confirms your facet joint syndrome diagnosis, he will develop a treatment plan that likely uses a combination of nonsurgical treatments. A conservative nonoperative approach is often the starting course of action, and this may include physical therapy and anti-inflammatory medication. Core strengthening exercises (eg, abdominals) and low back stretching are key to alleviate and prevent facet syndrome.

For some people, conservative therapy is enough to manage their spinal joint pain. Unfortunately, for some individuals they are unsuccessful and the doctor may move on to other minimally invasive nonsurgical therapies. These therapies include medial branch blocks, intra-articular (within a joint) steroid injections or radio-frequency ablation (RFA).

Intra-articular injections contain pain-relieving anesthetic and steroids that reduce spine pain associated with joint inflammation. On the other hand, medial branch blocks work on the medial branch nerves that arise from the facet joints that carry painful impulses to the brain.

If your pain is relieved by these blocks, it’s a good sign that you’ll also respond well to a nerve therapy with longer-lasting benefits known as radio-frequency ablation (RFA). RFA blocks the nerve’s pain signals by heating the nerves with radio-frequency waves. RFA may be an appropriate treatment if your spinal joint pain isn’t responding well to injection therapy. RFA provides extended pain relief—possibly up to a year.

Fortunately, these nonsurgical treatments manage most facet joint syndrome cases. However, in some case spine surgery is performed to alleviate pain long term. The typical surgery for this is a fusion either performed through an anterior (from the front) or posterior (from the back) minimally invasive approach.

Do You Need a Facet Joint Injury Attorney?

In our experience, we have found that facet joint injury cases are very challenging and will require aggressive legal representation if you hope to obtain full and fair compensation. The difficulty is proving your injury was caused solely by the accident and not by a preexisting “degenerative” condition.

Another difficulty arises because facet joint injections are used to relieve pain by anesthetizing the joints, the injections do not solve the underlying condition, only mask the pain. Injections frequently give support to the insurance argument that the condition being treated is an underlying degenerative disease. The difficulty with the insurance company occurs over the argument of whether the treatment would have been needed anyway, regardless of the accident.

Most personal injury lawyers don’t understand the true life altering nature of facet joint injury and settle these cases for far too less. At Phillips Personal Injury, we fight hard to obtain the full and fair compensation for our clients suffering from facet joint injury.

Adjusters love to put forward the “degenerative” conditions argument for the cause of your injuries and ensuing treatment, even if you have never been seen before by a doctor about this condition. In our experience, a facet joint injection case will almost always require representation for this reason. The reason adjusters fight so hard is because if you prove that the injections are related to the car accident, the insurance company is responsible for paying for any lost wages; your past and future medical bills; suffering, pain, and inconvenience.

We invite you to call us for a free consultation and we can answer any questions you may have.