Thoracic Facet Loose Body

When you begin to view pain from an endoscopic point of view, you will begin to see things that are rarely talked about as a potential cause of back or neck pain. This same phenomenon occurred, years ago, when arthroscopic knee surgery started to replace open knee surgery. There were things inside of the knee that was never seen when doing open knee surgery. It wasn’t as though these “new” things didn’t exist before; they just hadn’t been seen before. The structures that weren’t seen on the MRI would include plica, chondral defects, and small uncalcified loose bodies. They were always there but not recognized until inserting an endoscope inside the knee joint.

The same is true with the spine. There are things that are not seen on an x-ray or even MRI scans. The endoscopic view can reveal things never observed with open or “minimally invasive” surgery. Examples of such things include osteophytes that impinge and hypertrophic capsule and synovium that get pinched in the facet joints.

The video link below shows a loose body inside of a painful thoracic facet joint. The facet block of this joint gave complete relief of the mid-back pain. There is no way to definitively know if the loose body is the underlying cause of pain in this thoracic facet, but it is not supposed to be there and could be the cause of pain. This is an example of a small problem that can cause big pain.

Endoscopic spine surgery is the only way to visualize these small problems that can cause big pain. This is the type of pain problem that doesn’t usually respond to physical therapy, injections, or other conservative measures. The source of pain just remains a mystery until someone is willing to take a look inside of the facet joint, identify the problem, and treat it definitively.

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