Facet Joint Injection/Medial Branch Blocks
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Facet joints, located in pairs on the side of each vertebra in the neck and back, allow for motion and provide support and stability in the spine. Injury or conditions such as arthritis may cause pain and inflammation within the facet joints. A facet joint block or injection is a minimally invasive procedure in which a physician injects a small amount of local anesthetic and/or medication to numb a facet joint and provide pain relief. Fluoroscopy, a form of real-time x-ray, is used to guide the placement of the needle into the facet joint. A facet joint injection or medial branch block is performed to reduce inflammation, provide long-term pain relief, help patients tolerate physical therapy or other rehabilitative exercises, and/or help physicians determine the cause of back or neck pain.
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Procedure Benefits
Facet injections can tell us if the patient’s discomfort is due to arthritis or ligament tears of the joints in the back of the spine. They can also speed up the healing process of ligament tears. It is sometimes difficult to predict if the injection will help you or not. Patients who have pain in the neck, thoracic or lumbar regions determined to be coming from the facet joints themselves obviously do better. Similarly, patients with a recent onset of pain may respond much better than patients with longstanding pain.
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Length of Pain Relief
The steroid starts working in about three to five days and the effect can last for several days to several months with some cases lasting for several years.
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Facet Joint Injection Procedure Process
In most cases, the patient is placed in the prone position on the procedure table (facedown). All patients are monitored with heart rate, blood pressure, and an oxygen monitoring device. The skin overlying the treatment area is cleaned with an antiseptic solution and numbed with a local anesthetic. The injection needle is then placed under live x-ray (fluoroscopy) guidance into the joint. Once the needle is in the correct position, the medication will be injected. Typically we use a combination of local anesthetic and steroid as the injection medication. The local anesthetic will numb the joint, and if the pain significantly decreases, confirms that the treated joint is an actual pain generator. The steroid provides longer-term relief for the inflammation of the joint and its capsule.
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Amount of Time for the Procedure
Approximately 5-20 minutes depending on the number of joints that are treated.
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Preventing Procedural Pain
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The procedure involves inserting a needle through the skin and deeper tissues which can sometimes be painful. We do numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the spinal needle. Once numbed, placing the spinal needle often feels more like strong pressure and pinching than sharp pain. Some patients choose to receive intravenous sedation which can make the procedure easier to tolerate. Many patients choose to undergo facet injections without sedation and do well with very little pain throughout the procedure.
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What to Expect After the Facet Joint Injections
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Immediately after the injection, you may feel like your neck or back is numb. You may notice that your pain may be less immediately following the procedure. This immediate effect is also due to the local anesthetic injected. This will last only for a few hours. Your pain may return and you may have some soreness, worsening pain, or aching for a few days following. This is due to the mechanical process of the needle insertion, as well as the irritation from the steroid injected. Typically, you should start obtaining pain relief starting the third to fourth day.
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Post-Procedural Care
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With the possibility of numbness or weakness in the extremities due to the local anesthetic, it may make driving following the procedure both difficult and dangerous. All patients must have a ride home prior to undergoing the procedure. Most patients are advised to take it easy for a day or so after the procedure until the medication has a chance to work. Typically you can perform any activity that you were able to perform before the procedure without further limitations.
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Returning to Work After the Procedure
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You should be able to go back to work the next day. Occasionally, you will feel some soreness or aching at the injection site only.
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Procedure Risks and Side Effects
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Generally speaking, facet injections are safe. However, with any procedure, there are risks, side effects, and the possibility of complications. The most common side effect is pain from the actual injection once the local anesthetic wears off and this pain is temporary. The uncommon risks involve spinal puncture, infection, bleeding inside the epidural space, nerve damage, and worsening of symptoms. Other uncommon risks are related to the side effects of the long-acting steroid such as weight gain, increase in blood sugar in diabetics, water retention, and suppression of the body’s own natural production of steroids when steroids are overused.