A Useful Treatment for the “Dreaded” Degenerative Disc Disease
April 13, 2020It seems like every patient has it — the dreaded degenerative disc disease (DDD) with low back pain. As we all know, DDD is not a disease, and much to the surprise of our patients, it is just part of the normal aging process starting as early as age 30. This does not mean your patients don’t experience back pain, but how to treat the problem is another matter. Fortunately, there is radiofrequency ablation of the lumbar spine.
In most cases, as aging does not discriminate, DDD is associated with facet arthritis of the lumbar spine, and this is a very treatable condition. The pain caused from DDD is often not from the disc itself but actually from the altered mechanics causing painful arthritis in the facet joints between the vertebrae. Facet joints are the small joints in your spine between the vertebrae that enable you to bend and twist. Because of wear and tear (i.e., degenerative disc disease) and the aging process, the cartilage and fluid in these tiny facet joints dissipates, which can lead to pain and arthritis. In fact, it is thought that 80% of axial back pain emanates from the lower 4 (i.e., 2 on each side) lumbar facet joints.
The following should be considered diagnostic criteria to determine if pain is emanating from the lumbar facet joints:
1) Pain greater than 3 months
2) Pain is axial in nature; that is, there is an absence of persistent radicular/ dermatomal pain
3) Pain is reproduced by pressure over the facet joints
4) Persistence of pain despite participation in physical therapy and analgesic therapy
Most importantly, history, physical exam and imaging data are only suggestive of the presence pain coming from the facet joints. The major criterion for pain emanating from the facet joint is the response to a diagnostic block of the nerve supply to these intra-articular structures. The facet joints are innervated by medial branches, and a diagnostic medial branch block is confirmed if pain reduction is greater than 80%. Bilateral diagnostic medial branch blocks are a 5-7 minute procedure done in our offices under fluoroscopy; they are so safe that patients do not need to come off blood thinners. Time off from work is minimal.
If the response to 2 diagnostic injections are positive, the patient is a candidate for lumbar radiofrequency ablation (RFA) of the medial branch nerves that travel to the facet joints in the lower spine. Furthermore, we are comfortable telling patients that the RFA procedure may produce benefits of greater than 80% relief for up to 12-18 months. A systematic literature review would also confirm these assertions as there is Level II evidence (i.e., evidence obtained from at least one relevant high quality randomized controlled trial or multiple relevant moderate or low quality randomized controlled trials) that suggests the effectiveness of this treatment modality for 6 months or longer.
So no matter what you call it — degenerative disc disease or facet arthritis, there is an easy and effective treatment for axial low back pain that is safe and minimally invasive.
The Specialists in Pain Care Team!
