Raj N. Sureja, MD
Osteoarthritis of the spine is a common diagnosis that I make in consultation with patients every day. Spinal OA causes pain and dysfunction in the lower back and neck, can limit movement, and can also cause pain, numbness and weakness in the limbs, called radiculopathy. As an Interventional Pain Management Specialist, I routinely treat patients who suffer from Spinal OA and can often prevent them from having to have spinal surgery by performing a radiofrequency ablation (RFA) procedure.
Spinal OA can occur in two places in the spine – the vertebral discs and in the facet joints. The vertebral discs are not real joints, but because of their cartilaginous composition, they can be lumped into that category for clinical purposes. The facet joints sit on the posterior side of the vertebral bones and are true joints in that they have cartilage, synovial fluid and help the bones of the spine twist and bend side to side against one another. These very small joints are also important because they house and protect nerve roots that emerge from the spinal cord and branch off to multiple parts of the body.
When spinal osteoarthritis develops in the facet joints, they can become stiff and movement can become limited. Osteophytes or bone spurs can occur in the small space of the joint and can put pressure on the nerve roots, causing intense pain, weakness, numbness and even dysfunction, like drop foot or trouble grasping or holding items in one’s hand. Conservative treatment will be tried first by Spine specialists, which will include Physical Therapy, activity modification, NSAIDs, Oral Steroids or medications like Celebrex. If these fail to provide relief, an MRI will most likely be ordered to confirm or rule out other causes of the pain. At that time, the patient will be referred to me for Interventional procedures.
Before the Radiofrequency Ablation procedure, I can inject the patient’s affect facet joint with a steroid medication, for diagnostic as well as therapeutic purposes. Sometimes the injection provides pain relief for months, but it may only work for days. At least, we have a really good confirmation of where the problem lies. If the injection fails, I can recommend RFA.
Radiofrequency Ablation involves inserting a needle into the facet joint near the nerve root, that is compromised or under pressure by the bone spur, and then heating the needle and burning the myelin sheath off the nerve. The myelin sheath is an integral part of the nerve’s communication system – without it, the nerve can’t send pain signals to the brain. Viola, the pain goes away.
At some point, the myelin sheath will grow back, but often there is reduced or no pain when this happens. The RFA procedure can be repeated if the pain does recur. It is done as an outpatient procedure, the patient is numbed and sent home about an hour after the procedure is finished. My patients find it very effective at providing pain relief and function restoration for spinal osteoarthritis of the facet joints of the spine.
Make an appointment with Dr. Sureja or another OSC provider by clicking the “Request Appointment” button below or by calling (757) 596-1900.