When a person has spinal pain, plain film x-rays can be done that will show the outline of the bone and will detect the presence of bone spurs in facet joint disease. Discs, however, are made of soft tissue and are not detected on plain films. Plain films can, however, show narrowing of the disc space as is seen in degeneration of the discs.
A CT scan or MRI scan of the body can show a great many more things than a plain x-ray. These can show disc material impinging upon the spinal cord or on the spinal nerves. They can also show the presence of bone spurs at the level of the facet joints.
A CT myelogram can show fine detail by injecting a dye into the intrathecal space around the spinal cord. Areas of defect are revealed as places where the disc has herniated into the spinal canal or near the spinal nerves.
Treatment of Spinal Disc Injuries
Most people can undergo conservative management of their disc injury. The same is true if the disc is damaged in an accident of some sort. Surgery is reserved for those cases in which pain relief has not been relieved after conservative measures.
The first step in healing a disc injury is to avoid those activities that make the pain worse. This includes most sports and heavy lifting. There should be no activities that require you to twist or rotate the back or neck, depending on the location of the disc disease.
There are several exercise programs that aid in the recovery from disc disease. One of these is hamstring stretching, which can lower the stress on the back. Other back strengthening exercises can be done along with low impact aerobic workouts. Aerobic workouts can include walking, biking or swimming. Too much rest is actually not a good thing for disc disease. Staying mildly to moderately active is what will ultimately heal the back.
You can apply ice alternating with heat to reduce inflammation and reduce the muscle spasm around the spinal column. Ice has the added effect of reducing pain by gently numbing the affected area.
Medications used include nonsteroidal anti-inflammatory medication like ibuprofen, naproxen or COX-2 inhibitors. Even Tylenol can be used for pain relief. Some patients take oral steroids, narcotic pain relievers, or muscle relaxants, depending on their doctor and on the types of symptoms they are having.
Chiropractic manipulation can relieve the pain on a temporary basis. It uses bony manipulation to take pressure off damaged nerves and increase the spine’s range of motion. It can also relieve spasm of the muscles.
In some cases, the doctor can provide the patient with an epidural steroid injection. Steroids are delivered right to the affected area of the spine, reducing pain and inflammation.
If the pain does not get better using conservative measures, spinal fusion surgery might be recommended or perhaps an artificial disc replacement. These are surgical measures that can ease the pain of disc disease, especially if it is at one or two levels.
The most common segment which is fused because of disc disease is L5-S1. This is the spinal level most likely to break down over a person’s lifetime. Fusing the spine at this level does not much affect the mobility of the spine. Fusion of L4-L5 vertebral bodies does lessen the degree of spinal motion about the spine. This is a major segment for motion in the lumbar spine. A fusion at multiple levels is rarely done unless the patient has severely disabling pain from spine disease at multiple levels.
Treatment of Facet Joint Injuries
There are several treatments available for facet joint injuries that will allow the patient to live without pain. One such treatment is chiropractic care. The chiropractor can manipulate these joints so that they are in proper position and so that the spasm around the joints is improved. The chiropractor can order hydrotherapy, skeletal manipulation, activity modification, soft tissue massage, spinal adjustment, trigger point treatment, electrotherapy modalities, exercises, traction, and NSAIDs. Sometimes, several chiropractic sessions are recommended in order to progress from a painful spine to a painless spine.
Physical therapy can work to decrease facet joint pain. They can direct the proper kinds of exercises to relieve muscle spasm and increase the flexibility of the back. They can teach proper posture so that you always maintain the proper spinal curvature. They can teach the proper way to transition yourself from a lying to a sitting to a standing position.
Another form of therapy is called prolotherapy. It involves the injection of a non-pharmacological irritant into the facet joint, which leads to inflammation and the induction of a wound healing cycle. It strengthens the surrounding muscles and ligaments so there can be less pressure on the facet joints.
Steroids can be injected into the facet joint space to ease inflammation. The problem with injecting steroids too many times is that it can ultimately weaken the structures around the joint. This can lead to disruption of tissues and further pain.
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