The low back is a complex network of bones, joints, nerves, muscles and soft tissue. Each of these elements has the ability to cause pain that is felt in the low back. Low back pain that stems from the joints and bones of the low back is common and can be severely debilitating. In this article, we will discuss the symptoms, imaging and treatment for pain stemming from the bones and joints of the low back.
Which bones make up the spine?
The spine has a complex array of bones and joints that allows varied movements as well as protecting the spinal cord itself. In front of the spinal cord are the vertebral bodies which are separated by the vertebral discs. Behind the spinal cord are the posterior bony elements which include the pedicles, lamina, and articulating processes. These articulating processes make up the facet joints of the spine. Both the facet joints and the vertebral body/discs give us significant range of motion in the low back, but can also cause profound pain.
How can I tell the difference between the types of pain?
A detailed history, physical examination and advanced imaging performed by a Spine Specialist can help make the diagnosis. The history will include how long the pain has been present, does it radiate into the legs, and which movements in the low back typically make the pain worse. These questions are important because facet joint pain and vertebral body pain can sometimes present very similarly. They both will usually be pain that is felt in the low back without radiation into the legs. Where they differ is by which movements in the low back typically cause the worst pain. Normally the facet joints (back part of the spine) will usually hurt more with leaning back and twisting and the vertebral bodies (front part of the spine) will cause more pain with bending forward and moving from a sitting to standing position. In addition to these elements of the history and physical examination, imaging can help delineate the diagnosis. For facet joint pain, both X-ray and MRI of the low back can show findings of arthritis of the joints. For vertebral body pain, MRI will show changes in the structure of the vertebral body to help establish the diagnosis.
What are my options to treat my pain?
Conservative Therapies
Options include lifestyle modifications, physical therapy, medications such as NSAIDs (Ibuprofen, Aleve, Advil, Meloxicam, etc.) and Tylenol Arthritis, biofeedback techniques, etc. Many patients will see at least some benefit from these conservative treatments and many will find that they are adequate to control their pain.
Interventional Therapies
These are non-surgical treatments that are available on an outpatient basis.
For facet joint pain, steroid injections can provide some short-term relief for about 3 months while nerve ablation treatments can provide longer term relief from 6 months to 1 year or longer. Nerve ablation involves delivering a burn through the tip of a needle to the nerve to disrupt its abilities to send pain signals to the brain.[1]
For vertebral body pain, there is a specialized type of nerve ablation called the Intracept procedure (basivertebral nerve) that can help reduce pain by disrupting pain signals being sent by the basivertebral nerve to the brain. While it is not yet known the duration that the Intracept procedure lasts, the most recent data point to a durable relief of pain for up to 5 years or longer.[2]
Surgical intervention
Some cases may require surgical intervention including cases of severe, debilitating pain which hasn’t shown improvement with other therapies or when instability is causing the problem. A careful weighing of the benefits and risks will be done together with your surgeon to help determine if you might benefit. Surgery will typically be targeted at stopping motion that is causing pain in the bony structures in the spine.
Resources
- Radiofrequency Ablation for Facet Joint Pain – https://my.clevelandclinic.org/health/treatments/17411-radiofrequency-ablation
- Intracept for Vertebral Body Pain – https://www.relievant.com
[1] Klessinger S, Casser HR, Gillner S, Koepp H, Kopf A, Legat M, Meiler K, Norda H, Schneider M, Scholz M, Slotty PJ, Tronnier V, Vazan M, Wiechert K. Radiofrequency Denervation of the Spine and the Sacroiliac Joint: A Systematic Review based on the Grades of Recommendations, Assesment, Development, and Evaluation Approach Resulting in a German National Guideline. Global Spine J. 2024 Sep;14(7):2124-2154. doi: 10.1177/21925682241230922. Epub 2024 Feb 6. PMID: 38321700; PMCID: PMC11418679.
[2] Fischgrund JS, Rhyne A, Macadaeg K, Moore G, Kamrava E, Yeung C, Truumees E, Schaufele M, Yuan P, DePalma M, Anderson DG, Buxton D, Reynolds J, Sikorsky M. Long-term outcomes following intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 5-year treatment arm results from a prospective randomized double-blind sham-controlled multi-center study. Eur Spine J. 2020 Aug;29(8):1925-1934. doi: 10.1007/s00586-020-06448-x. Epub 2020 May 25. PMID: 32451777.
This information has been medically reviewed by Douglas Hunter, M.D., minimally invasive pain relief and neuromodulation specialist at Olympia Orthopaedic Associates.
IMPORTANT: This content is for general information and education only. It is not medical advice and is not intended to diagnose, treat, cure, or prevent any condition. Do not use this information to make decisions about your health without speaking with a qualified healthcare professional who can provide advice tailored to your situation. If you have symptoms, an injury, or a medical concern, contact your healthcare provider. If you may be experiencing a medical emergency, call your local emergency number immediately.