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Bad Facet Joints Lumbar Spine. Help Please

Hi, I'm Karen. Ive been reading posts for a long while now

hoping that someone has the same issue as me in the back.

First, Ive been to Mayo Clinic and saw the best Rheumatologist

and spine doctor. Both agree that my facet joints are really worn

down to nothing but I am 48 years old and they will not do a

surgery on them because 70% of all people who have that surgery

fare worse...I don't know how I could possibly fare worse. My back

gives out at least 4 times a day. I mean that I must lean my 118lbs

onto a counter or a chair or else I fall right down. They did facet

joint injections with steroids, they did an ablation on the nerves and

yet I have this going on. To walk one step further means that I will

be grunting to get there. It's 100% relief when sitting or laying down

and hurts a 10+ if suddenly my back gives out. I walk with a forward

stoop whenever that happens and a crane could not pick me up to

walk upright. Mayo Clinic was told that it was this bad several

times. They are doubling up pain pills - which I hardly need because

sitting down relieves it but they said to take them before I go to

physical therapy. Now I don't mean to sound like I am bragging but

I am in tip top shape. My abs are rock hard and I work out the core

of my body under the care of a certified personal trainer who deals

with injured people. I started that when I blew my knee out and was

without exercise for a good 6 months. So given that I won't be in touch

with Mayo until after I do a 12 week program, Can anyone help me?

Please tell me that someone knows what and why this is happening.

X Karen

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Hi Karen, it frightens me when u say your abs are rocks hard and you've been working out! Time to stop! Take stock and figure out what's going on? Clearly the instructor is NOT helping! Slow down and see a physical therapist. No more 'core stability' training. πŸ‘ best wishes

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I did my core training before l had the back issue. I am

Avoiding the sore spots obviously. My physical therapist

Has instructions to keep the core muscles strong but l can't

Do certain movements like twisting and turning, other stuff.

I'm so bad off just recently that all that my PT wants to do

Is to release by movement, some of the muscles. I have deep

Ultrasound heat treatments and light movements. I am done with the personal trainer as of today until later. My point is that my

Back keeps giving out so the problem being the facet joints

Will never get fixed..then will my back give out for the rest of

My life? There's nothing left of them.how can physical therapy

Work for me?


Thank you for stopping me. I prob stretched some ligaments and now my muscles are doing the work for them. I have to see Mayo Clinic Surgeon to make sure that it's not something worse. I am going to be working on spinal decompression still movements just to get the job done. It's stretches that will not injure what already is. It's with the physical therapist. He or She *I've had both now* said to rest everything. I believe that I feel just a tinge better tonight. ( am in the USA. Waking up is a habit for me now. I have restless legs.


Hi there, I'm glad you've slowed down a bit. I know only too well the distress that comes with acute facet locking! In my view this condition is usually a secondary problem to a disc problem. Have you had an MRI done? If so have you been told how your discs are? If you have a tear in a disc or a prolapsed disc this could account for your back locking up so frequently as the nerves becomes super sensitive and lock the back if they perceive danger. This is an over-response and John's arousal stuff down below fits in here as your central nervous system has possibly gone into over drive! What to do then? Well, gently rocking your knees to chest is a good start but you need MRI and Valium to break the spasm cycle. I personally would forget prolotherspy. It used to be called scelerotherpy. I had it done and was a load of expensive rubbish peddled by snake oil salesmen. According to Cochran review no better than placebo!


Sorry, I had to dash for a few minutes.... Anyway, I would also say that steroid injections do have their place in calming down acute inflammatory back problems. A correctly placed needle at the right time by an excellent doctor can relieve a nerve that is being irritated by noxious disc exudate and can help you get moving normally again. normal movement begets normal movement. You may need a few weeks of anti inflammatories to again relieve irritated nerve to stop the acute back spasms and most of all you need to calm your thoughts. Lie down and count slow breaths. Put your legs up on a chair. Be still and quiet and feel the weight of your body sink into the floor....


Mayo injected steroid into my facet joints and was going to do the ablation but the test injections did

nothing for me so we pulled back from that one.

I am still having my back go out and am starting to lean forward when walking to elevate pain and to stop my back from going out. Below this is the whole series of my lower spine and the Cervical -

Mayo Clinic put me on Rituxan and today is my last dose. I am also on methotrexate and I do get kenalog steroids before my Rituxin.. the result is that the spine is feeling better except lower back and the fact that it gives out on me. It seems to be so complicated that Mayo is quitting on me.

I have a past of inflammatory issues with a few joints so I am seeing Rheumatoid specialist, a nuclear scientist for my neruropathy all 3 kinds moving fast...

I have CIDP ....they said...but no muscle wasting...

Thank you for your time and consideration.


Sorry, I missed this comment about cidp before replying! Yikes! Indeed! Still think it's possible to have an extra problem superimposed on the cipd and again, helping sort out antero/postero spondys needs subtle and gentle treatment. Best wishes


COMPARISON: 12/15/2014 lumbar spine and pelvic MRI. 12/8/2014 pelvic,

sacroiliac, and spine x-rays.

IMPRESSION: Multiple sites of increased tracer uptake in the lower

thoracic costovertebral junctions and multiple lumbar facet joints.

Otherwise normal study. No evidence of fracture or sacroiliitis.

INDICATION: Low back pain.

FINDINGS: Blood flow and blood pool images of the lumbar spine and

pelvis are normal. Delayed planar images and SPECT/CT of the lower

thoracic and lumbar spine demonstrate multiple sites of increased

radiotracer uptake at the left T9, left T10, bilateral T11, and

bilateral T12 costovertebral junctions. There is also increased

radiotracer uptake within the right L3-L4, bilateral L4-L5, and

bilateral L5-S1 facet joints. These may be a source of pain. There is

also mild increased activity about both SI joints; CT fusion images

demonstrate SI joint peri-articular sclerosis and intra-articular

vacuum phenomenon, both of which point to degenerative arthritis.

There are no findings to suggest thoracolumbar, sacral, or pelvic

fractures or sacroiliitis. Degenerative uptake at the sternomanubrial

junction. Remainder negative.

TECHNIQUE: Three-phase bone scan of the lumbar spine and pelvis.

Delayed views of the thoracic spine, lumbar spine, and pelvis. SPECT


ORIGINAL REPORT - 15-Dec-2014 10:59:00 SMH

EXAM: MRI Lumbar Spine without and with IV contrast

MRI PELVIS wo&w (accession 17589896-3); exam performed according to

the spondyloarthropathy protocol

COMPARISON: OS MRI lumbar spine MRI 5/9/2014

IMPRESSION: No convincing findings to suggest sacroiliitis.

FINDINGS: Normal alignment. Conus medullaris ends at L1-2 and is of

normal signal intensity and appearance. No substantial spinal canal or

neural foraminal narrowing. No convincing bone marrow edema or

abnormal enhancement within the lumbar spine.

Within the sacrum and to much lesser extent within the iliac bones

there is generalized minimal T2 hyperintensity in the suggestion of

enhancement. Given the geographic distribution without centering

adjacent to the sacroiliac joints, findings are more suggestive of

artifact rather than oral enhancement. No enhancement within the

sacroiliac joints. No adjacent erosions. Minimal sclerosis of the

iliac bones at the anterior inferior aspect of the sacroiliac joints.


Pelvis w/Sacro-Iliac obl. 3vw:

Entire Spine X-ray:

IMPRESSION: Grade I anterolisthesis C3 on C4 and C4 on C5. Cervical

facet joint arthritis. Slight thoracolumbar curve. Minimal

retrolisthesis L3 on L4. Grade I anterolisthesis L4 on L5 and L5 on

S1. Lower lumbar facet arthritis.

Mild sclerosis of the SI joints bilaterally. Bilateral coxa profunda.


Grrrrr.... I replied to this and it hasn't saved and entered! A long reply too! Anyway, short answer is your lumbars are tipped at odds to each other and you really need gentle movement and stretches to encourage your curves into better alignment. It is possible to have an acute disc superimposed on background conditions... Did u test positive for ankylosing spondylitis ?


Thank you Boozybird for your thoughts. There is no smoking gun as to why this is happening to my back. It shouldn't be locking up from what l can see unless it looks and behaves differently when standing up. The frustration is there on my surgeons face.. funny thing. He won't do surgery of any kind at Mayo but at home the surgeon wanted to replace facets with a new system and fuse the spine. I knew enough to deny that treatment. The fusing was all wrong. I am one to deny painkiller use I take one to two per day, if that. It hurts when standing still even for a moment. I get 100% relief when sitting or laying down.


No one likes taking medication but some ARE invaluable short term. It really sounds like you have back spasms which are most likely there for a reason but the problem is they keep on keeping on and start to create their own problems... Ask your doc for Baclofen or Valium. The former doesn't make you silly in the head like Valium and works specifically for spasms affecting the back and cns. I took it for a couple of years to stop embarrassing incidents like falling to the floor in agony in public! It will either help or not and then you have another piece of the puzzle.... 😜

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Baclofen, gotta love it. My arms jerk from it lasting 2 days or so. Valium probably has to be prescibed in place of it. The ClDp is a diagnosis prob to keep their hands on my case. Im too strong for that. I have neuropathy and it happened almost overnight. Mayo is not going to let me go... im on an open nationwide study because i dont quite fit any diagnosis. I test positive for lupus but not enough symptoms and other neurological conditions but the symptoms are,absent or not enough and same with rheumatology. Funky blood tests are there as well telling them that lm sick with these diseases. Mayo is most intregued by it. Im not a happy camper. Im mgus too. My spinal fluid has protein but low white cells. They did lip biopsy, negative. I feel okay except my back.. thank you for the help.


What a bummer for you. Sorry couldn't be more help. Best wishes


See an Alexander Teacher.

Your posture is in serious trouble. Stop the exercise and look at gaining greater sensitivity in the use of your muscles. Once your have the postural balance and good sensitivity in muscle use then go back to physical exercising.

Steriod injections attack and damage ligaments. Look up this serious side effect on the internet.

Strong muscles can damage bone, tendons and pull your back out. If ligaments are damaged by steroid injections than the back will go out much easier.

Hope this helps

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Thanks Johnsmith. I did look it up and Bingo.. you are right

about the steroids. I am not built with defined muscles..

I just have well toned body. Now I wonder if it's even possible

to have strong muscles that could damage my bones?

I think that what you thought I should do is what my Physical

therapist is doing because he's not working any muscles but

he's stretching the legs and massaging out the knotty muscles.

I feel like it's not even worth my time to have someone doing this.

My leg falls into his hands and he moves the legs- not me.

I live in the USA, I have never heard of an alexander teacher.

Prolotherapy is the newest thing over here..

especially for low back pain.


Ive never had it and don't know anyone who has personally.

Again thanks for any help on this.

I ice, heat, pain rubs, tens machine, massage,

body scan relaxation, meditation, pray and

haven't found relief yet.

Mayo Clinic suggested getting into a swimming pool to

do some water walking. Maybe I am not explaining the

pain and area that hurts so bad. I am a little bit emotional

over this. It's cramping my lifestyle hugely. XX Karen


Prolotherapy works for me. Especially the facets and ribs. It can be expensive but in the end it worth it. If you want a good recommendation you can email me faithdella@gmail.com. Prolotherapy utube video I recommend dr ross hauser in Illinois. Sometimes my pain come back. I could scream. So I have to have another round of therapy and again I am painfree. I also have autoimmunity issues which makes healing much more difficult but thank God not impossible

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Me too.. same with autoimmune. I am eating to heal

that autoimmune stuff.. I used to eat healthy but blow

it on the weekends. Then I ate my share of junky foods.

I'm going to have a look at that prolotherapy... seems

like everyone is talking about it in pain clinics and

at my Rheumy appointment... No one had it yet but

the talk is hot and everyone wants it.. I am in Wisconsin

near Green Bay/ Appleton.. I will look closer to home

but will consider Illinois. Heck, I've been going to Mayo

in Rochester for the past 6 months. What's a trip to


I read that the procedure lasts a couple months. I also

read that it's sugar based stuff that goes in the spine.

I don't know if I like that idea. Sounds like they are

making a cake in there with the other oils and ingredients.

Pretty Scary but if it's helping you, I might do it...

depends on what my doctors at Mayo think.. I haven't

brought it up to them.

My back is out right now.. it's been out for a few hours..

I could walk around stooped over like I am watching

ants crawling on the ground.. or hands to toes...

Do we have Alexander Teachers in the States? Im

looking and not finding.. will talk with you on this,

I promise.. even if I don't do it, I want to hear about

it. X Karen


Hi, I will be 60 this year and I have had the same problems as you since I was 23.It started with Ankylosing Spondylitis, and over time my spine and facet joints have just deteriorated. I too have had all the recognised treatments.I was on massive amounts of morphine ( 140mgs 4 times daily ) and nothing was helping.I then saw an article on cryotherapy, and my life changed.Cryotherapy really has given me back my useful life.When I first tried it, I thought it was just another gimmick, but I stuck with it, and I'm glad I did.It sounds a bit drastic being in a chamber in your underwear in temperatures of -130ΒΊ, but it actually works for me.The funny thing is your breath falls as snow.I would really recommend you try this treatment if it is available in the States.It's really been a life changer for me.

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Thanks for the reply.

I learnt from experience and the administrations of a McTimony chiropractor that tight muscle will cause a bone to hurt if the muscle has been tight long enough.

Pain is not something you can necessary find relief for. There are too many possible variables ranging from the cramped muscle in your big toe causing pain in your finger. Yes that is possible because everything can be so inter-related. There are ways of reducing the emotional impact of pain so that it bothers you less.

Sometimes, a system is stressed past its engineering stress breakdown point and pain kicks in. The causes of the pain are multiple and all these little causes have to be removed before things quieten down.

All you can do is try a multiple of different things and see which one works. It is a suck it and see.

There is something known as catastrophe theory.


If you have any questions ask I might be able to answer them or someone else on this forum may be able to answer.


The biggest problem sounds like the medical treatments you've gotten! If you haven't seen a chiropractor, I highly recommend it. There's only so much one can do, but at least they won't harm you like these guys have, and the human body has a tremendous ability to recover and adapt, so give it a go.

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Thanks for putting time into this .. better start over or I will seem like a liar.

Played a lot of sports. got a good kick in the knee at age 44.. went into

surgery. Left knee in pieces. busted part of femur and again during removal

of prosthetic knee due to infection. They replaced the plate only at that time.

Doctor washed knee out and put on antibiotics. Dr. says knee looks like you have RA or some gout in there. Surgeon contacted the Rheumy to get a date for me to see him.. Knee infection wouldn't go away.. plate out again, wash, antibiotics. Called in infection specialist - says infection cleared. went home. Knee swelled with fluid- too much fluid = took out 11 beer cans of fluid. Had inflammation said the surgeon and infection specialist and had crystals. Not gout. sent me to Rheumy who said psychotic arthritis. to treat me with remicade in 4 months. fever spikes knee fills up again and this time fluid looks infected, is infected with staph.. put in hospital again.. no improvement, getting septic (me) so knee comes out, good wash, puts spacer in knee says this looks like RA.. more antibiotics. Puts knee back in at 12 weeks, knee gets infected.. maybe not.. fluid comes back with too much white cells to be infection, looks like inflammation. again fever spikes and went through this before doctor says last try.. number 6...and puts it back in. This time so much damage in there that he builds me a special knee.. so I can play sports but not as good as first knee..Ahh.. this one works.. Karen is very happy.. then 3 months later starts RA drugs..takes for 3 years. no improvement on body = it just hurts me including back. My back never stops hurting... so they send me to area specialists who say Anklos spondy.. great... changes to Simponi drug..

Then neuropathy starts.. moves really, really fast.. did the usual tests to

check that out.. Neurologist says to get to Mayo instantly she thinks I have

Gillian Brae Syndrome or something. My legs didn't want to go up steps.

Local doctors make me see other specialist who sent me to a surgeon who wanted to fuse the back and do lumbar facets.. Pretty soon I am seeing every

doctor. I had panic attacks going on - so I went int the CT for heart .. wore halter monitor for 1 week. BP shows 40 pt difference between standing and laying down. I start passing out. Lungs fill with fluid.. lung collapses..

Insurance Company demands that I go to Milwaukee teaching hospital... who takes one look at my chart and says go to Mayo instantly.. My home doctors wait longer before finally referring me..

We are the only people that ever had an insurance company that made me go no matter what the cost.. CIDP can be very expensive. so I have my Rheumatoid problems even though I can kick high and move easily... and I have neuropathy moving fast , CIDP signs... steps are hard for me.. or were.

I stayed at Mayo, nerve biopsy came back DEAD... says CIPD.. Rheumy doctor at Mayo says yeah something is wrong.. big white cell no infections.. back is not looking good here.. so sent all around the hosptial to most departments.. little leg swelling going on from Lyrica - past use of gabapentin.. has restless legs too... so using mirapex.. gotta be all of those.. has ankles and feet tightly wrapped.. my knee still doesn't look all that good..

Mayo put me on Rituxin to kill rheumatoid, MGUS and will take care of CIPD

that they are sure I have. ..

And here I am today with a back that is killing me.. I feel sort of forgotten about

so back surgeon is going to look at SI joints. I had to keep calling to bug them. They told me to go home and learn to live like this in a pain program. they gave me videos to try to put it in my head that ti will take funding to address what is really going on.. because they can't find a smoking gun and yet I am going through all of this.

It's pathetic really.. I just want my back fixed, relief from neuropathy.

Without medicine, I can't live my life.. even the 2 oxy or even 1.

I tried to fix myself by working out and eating less for my body so I

could get better faster..

Please don't think that I am a liar.. even though it sounds that way..

It's been a learning experience. I just want my back fixed today. I

couldn't even get up. I fell onto the floor to get up that way.. I don't

think that they nailed this one.. but then again....we tried bacofen..

to me it's a dangerous drug...My arms are jerking up and down hard

from it.. It's not worth it to me.

Thank you again for your help Boozybird and Johnsmith. we tried..




Patient complains of pain. Location: back.

On a scale of 1 to 10, patient rates pain a 6.


I had a long and detailed conversation with this patient. She understands that her symptoms are still consistent with

mechanical low back pain. The nuclear medicine bone scan did show tracer uptake in the lower lumbar facet joints

on the right at L3-4 and bilaterally at L4-5 and L5-S1. There was also increased radiotracer uptake at the left T9 and

left T10, bilateral T11 and bilateral T12 costovertebral junctions. I have explained to the patient that this increased

activity at these joints is likely what is causing her pain. Unfortunately, she has not responded well to facet joint

injections. I think it may not be unreasonable to see if she can be seen by our Pain Clinic colleagues and perhaps

undergo medial branch blocks with RFA in the lower lumbar spine. Perhaps this might help her more definitively

than the facet joint injections did. We will get our Pain Clinic colleagues' opinion regarding this, especially given

her multiple other problems.

This was discussed at length with Mrs. Mandel. She is comfortable with this plan. All of her questions were



#1 Mechanical low back pain

#2 Advanced DJD, lumbar spine

#3 Mild multilevel degenerative disk changes

#4 Bilateral lower extremity peripheral neuropathy, thought to be inflammatory


My notes.. ablation didn't happen, test injections made it worse pain.

Multiple other problems referring to so many infections in my past

and edema from Lyrica.. gabapentin.


If 70% of all people who have that surgery fare worse take the hint. Take care.

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Hi Karen, I'm so sorry to hear that you are experiencing this. Though my pain is in my upper back and neck, I too have had the facet injections the trigger pointe injections, I've had chiropractic and physical therapy care and are still in pain after 15 months. I began seeing a omt Dr who really made me feel great after my first appt, but the pain levels are still so high! I know how it feels to be so frustrated with no real answer or relief. I tried getting into mayo clinic but they had not had any room saying there spinal dept is booked. How long have you been experiencing this for?


Hi Karen

So sorry to read about your terrible pain, I can really sympathise with your lower back pain. I am in the UK laying in hospital following by my second back surgery on a different level of my lower back. Like you I was trying to do everything I could to keep myself going on a daily basis. I suffered for a lot of years with lower back pain starting in 200, I went through all types of osteopath, chiropractor and physio treatment, had a pain management team who did vast numbers of pain injections, epidurals, nerve blocks and the like in my lumbar L4/L5 L5/S1 and had my facet joints drained a number of times, all these things provided short term relief. In 2007 my sciatic nerves in my legs started to give me pain too. Do you have any leg pain, as couldn't see you had mentioned?

The result of the first op was fabulous it gave me my life back. I recovered fully and I feel really good today after my second op so am hoping for the same outcome with this one!

My first op was in July 2012 where I had Decompression with instrumented Fusion and Rhyzolosis on L4/L5 where I had a fabulous outcome. I went into the operating theatre crying with pain having to lay flat on the bed and woke up about 3 hours later with no pain in back and legs and it stayed that way until earlier this year in 2015 when I started to experience different symptoms, lots more back pain this time and really heavy achy leg pains.

My second op, done only yesterday, was due to be a Decompression and Discectomy on L3/L4 with Rhyzolosis but once he had cut away all the severely arthritic facets and thickened laminar he didn't have to touch my disc.

I don't have my MRI reports to hand here but I was diagnosed EVENTUALLY after 11 years of lower back pain and horrendous sciatic leg pain by a Mr Rai of Norwich Spine Clinic in England., he is absolutely first class. My GP referred me to him in July 2012 when all else was failing. I might add my GP has been brilliant all through the years and he could see things were not working.

I have read through most of your posts and am just picking up on one comment you made that affected me. You said your MRI report states (amongst other stuff) Grade I anterolisthesis L4 on L5 and L5 on S1. Lower lumbar facet arthritis. You said 'unless this changes when standing'. IT CAN.

If you haven't had standing plain X-rays then I would recommend that you ask for them to be done asap. I had seen orthopaedic and rheumatoid specialists numerous times during all the years I had my back pain along with 5 MRI scans and two emergency admissions to hospital one in 2007 and one in 2012, all by the NHS and was told there was nothing that an operation could do to relieve my pain.

It wasn't until I saw Mr Rai, which I paid for privately so I could see him urgently as I felt Β£250 was well worth it! He told me if I didn't have an operation, within 6 months I could be paralysed and in a wheelchair. I had a Grade 1 spondylolithesis at L4/L5 which changed to a Grade 2 when standing. I also had severe spinal stenosis, severe facet joint arthropathy and bulging discs. Like you sitting was total relief, standing and walking was agony. Laying down I could find a comfy position on my side some days but laying on my back with legs flat was agony, knees bent up was good.

My consultant gave me the outcome on a percentage basis, I think he said something like he thought he could get rid of about 70 % of my leg pain and 60-65% of my back pain, 15% of patients may not get any better and 5% could get worse. I understand that you have other complications but it seems to me as a lay person with no medical experience only personal experience, that your back symptoms are the ones that are causing you so much pain. I walked with a slight bend just to make things easier but I know that my consultant has helped a youngish lady (her video is on the website below) who was bent right over forward so I am sure there is something that your hospital can do for you. If it is a fusion op with instrumentation to realign your slipped vertebrae I would say weigh up your life against your pain. Which is controlling which?

Sure you have websites like my consultant has that you have looked at but here it is just in case you would like to have a look. norwichspineclinic.co.uk

I hope that my experience may have been able to give you some comfort. Good luck and I hope you can get some relief soon.


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