Facet Blocks

Published on January 2, 2012 by in Procedures

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Facet Joint Injections                Facet Medial Branch Nerve Injections

Facet Blocks/Injections: these are injections into either the facet joints directly, or on the “medial branch” nerves to go into the facet joints. Facet blocks (i.e. nerve blocks for facet pain) can be done in all levels of the spine, including the cervical (neck), thoracic (upper and mid back), and lumbar (low back) spine.
Common Indications for Facet Blocks: Facet blocks are used to treat facet mediated pain. The “facet” joints are small joints between two connecting vertebrates. The vertebrates are the spine bones that make up your spine. These facet joints, like all bony joints in your body, can become “inflamed” and develop “arthritis”. Consequently, you will develop pain in the area of the diseased facet joints. For example, if the cervical facets (in the neck) become diseased, you will develop pain in the neck. Likewise, lumbar (low back region) facet disease would lead to pain in the low back. Facet pain is usually localized to the area of the spine where the facet joint is inflamed (i.e. diseased). There are currently no definitive radiological or blood test to diagnose facet mediated pain. One of the best method to diagnose facet mediated pain is with facet blocks. Facet Blocks can be both “diagnostic” (i.e. confirm the diagnosis of facet mediated pain) and “therapeutic” (i.e. provide pain relief).
Technique:  At SCCPM, facet blocks are performed at the surgery center under live x-ray (fluoroscopy) for safety and accuracy.  The doctor may order IV sedation (i.e. “twilight sleep”) as an option for your comfort.  You will be checked in at the surgery center and brought into the operating suite, where you will be greeted by the doctor and registered nurse.  After placing monitors (e.g. blood pressure cuff, EKG, pulse oximeter, etc) on you, the nurse will give you IV sedation (if ordered).  Afterwards, the doctor will begin by “numbing” the injection site with a local anesthetic.  Afterward, with the aid of the fluoroscope, Dr. Lee will perform the actual injection(s), in which a local anesthetic +/- steroid combination is used.  After appropriate monitoring, you will then be transferred to the recovery unit before going home with a family member or friend.  You are encouraged to “take it easy” for the rest of the day, and to follow the post-procedure instructions ordered by Dr. Lee.  You will be able to resume your normal activities the next day.
Pain Relief Response and Duration: Most patients can expect pain relief immediately or 1-2 days after the injection(s). The immediate relief is due to the local anesthetic, while the long term relief comes from the steroid.  If a steroid mixture is used, most patients can expect to have duration of pain relief for months or even year(s). However, there will be a minority of patients who do not respond or respond only temporarily. Again, there is no way for Dr. Lee to predict your response as each patient’s pain and response differs. However, if you indeed have facet mediated pain, you should have pain relief with this type of injection.

As with all medications, the steroid drug will wear off with time and you may require repeat injections. There are currently no rule as to how many injections a patient will need and how often. It is up to the patient and Dr. Lee to decide on the number and course of treatment needed. In general, if the facet blocks prove beneficial, Dr. Lee can then recommend Radiofrequency Ablation of the facet medial branch nerves for long lasting pain relief.

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