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¿Qué son las inyecciones facetarias? ¿Qué son los bloqueos de la rama medial?

  • Son inyecciones que tratan el dolor proveniente de la artritis de la columna.

La artropatía facetaria es la artritis de las pequeñas articulaciones pareadas que se encuentran en cada nivel de nuestra columna vertebral. Cuando los tratamientos conservadores, como la fisioterapia, la medicación y las modificaciones del estilo de vida, no logran aliviar adecuadamente el dolor de cuello, las técnicas de tratamiento intervencionista del dolor pueden ofrecer soluciones eficaces. Estos procedimientos mínimamente invasivos pueden dirigirse directamente a las articulaciones facetarias, administrando medicación para aliviar el dolor y reducir la inflamación en su origen, o indirectamente, dirigiéndose a los nervios que transmiten señales de dolor desde la zona dolorida.

Una terapia de inyección comúnmente utilizada para la artropatía facetaria es la inyección de esteroides en la articulación facetaria y los bloqueos de la rama medial.

  • Inyección de esteroides en la articulación facetaria: durante este procedimiento, se inyecta una combinación de anestesia local y medicación con corticosteroides en la(s) articulación(es) facetaria(s) afectada(s) bajo guía fluoroscópica (radiografía). La anestesia puede proporcionar un alivio inmediato del dolor, mientras que el corticosteroide actúa para reducir la inflamación y proporcionar un alivio más duradero de los síntomas. Las inyecciones en la articulación facetaria se pueden realizar en la columna cervical, torácica o lumbar, según la ubicación del dolor. Esperamos un alivio del dolor a largo plazo con la inyección de esteroides, pero el alivio rara vez es permanente.

  • Bloqueo de la rama medial: Otra terapia de inyección que se utiliza a menudo para el dolor de cuello causado por la artropatía facetaria es el bloqueo de la rama medial. A diferencia de las inyecciones en las articulaciones facetarias, que se dirigen directamente a las articulaciones, los bloqueos de la rama medial se dirigen a los nervios que suministran sensibilidad a las articulaciones facetarias. Al bloquear estos nervios con un anestésico local, los bloqueos de la rama medial pueden interrumpir temporalmente la transmisión de señales de dolor, lo que proporciona un alivio a corto plazo para los pacientes con dolor relacionado con las articulaciones facetarias. Estas inyecciones tienen como finalidad el diagnóstico (nos indican cuánto dolor proviene de las articulaciones facetarias) y no se espera que proporcionen un alivio a largo plazo. Los pacientes que experimentan un alivio significativo y temporal (que generalmente dura entre 2 y 24 horas) son candidatos para la ablación por radiofrecuencia, un procedimiento que tiene el potencial de proporcionar varios meses o años de alivio del dolor.

Inyecciones en la faceta cervical

Qué esperar durante los bloqueos de la rama medial o las inyecciones facetarias

Facet block or medial branch block may be therapeutic and/or diagnostic. One of three things may happen after the procedure:

  • The pain does not go away, which means that the pain is probably not coming from the blocked facet joints. This has diagnostic value.

  • The pain goes away and stays away for a few hours, but the original pain comes back and doesn't get better again. This would mean the block was also of diagnostic value, indicating that the pain is probably coming from the joints but the steroid was not of benefit.

  • The pain goes away after the block, may come back later that day, but then gets better again over the next few days. This means that the block was of therapeutic value, because the steroid had a long lasting effect on the pain.

  • If you get a positive, lasting benefit from the injections, the block may be repeated.

  • If you get a positive, short-term benefit, another procedure called radiofrequency lesioning may be done which may last months to years.

What are the risks of the procedure?As with most procedures, there is rare risk of bleeding, infection, nerve injury or allergic reaction to the medications used.  Some short-term side effects may occur.

  • If local anesthetic spreads to nearby nerves, you may have weakness or numbness that can last for several hours. If this happens you may have to stay in the Pain Management Center until this resolves.

  • You may have increased pain for a few days after the injection, including localized pain at the injection site.

  • People with diabetes may have short-term elevation of blood sugars.

The procedure cannot be performed if you have an active infection, flu, cold, fever, or very high blood pressure. For your safety, please make your doctor aware of any of these conditions.W

 

Will the injection hurt a lot?Most people say the stinging/burning of the numbing medicine is the most uncomfortable part of the procedure, although every person's response to any procedure is individual.

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What happens during the actual procedure?After you sign a consent form and your blood pressure is checked,

  • the procedure will be done in the fluoroscopy (x-ray) room with you lying on your stomach.

  • The back or neck is then cleansed with an antiseptic solution and sterile drapes are placed.

  • The skin is anesthetized (numbed) with a local anesthetic. This is felt as a stinging or burning sensation.

  • Using x-ray guidance, needles are then advanced to the appropriate locations (the joints or the medial branch).Once the needles are in the proper location, local anesthetic (with or without steroid) is injected through the needles, and the needles are removed.

  • Your skin will be cleansed and bandages will be applied. The bandages can be removed on the next morning. Your blood pressure will be checked, and you will be able to leave with your ride after the doctor authorizes your discharge.

How will I feel after the injection?Your back pain may be improved immediately after the injection from the local anesthetic. Some local tenderness may be experienced for a couple of days after the injection. Using an ice pack three to four times a day for twenty minutes at a time will help this. It is important that you keep track of the amount of pain relief you received as well as how long the pain relief lasted. This will help to guide what subsequent procedure, if any, is right for you.

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Will I have any restrictions on the day of the procedure?​ 

  • You should not drive for the remainder of the day after your procedure. An adult must be present to drive you home or to go with you in a taxi or on public transportation.

  • For your safety, the procedure will be cancelled if you do not have a responsible adult with you.

  • No heat is to be used in the injected areas for the remainder of the day. 

  • You may eat, drink and take your medications as usual on the day of the procedure (both before and after).

 

Please follow these instructions unless told differently by your doctor.For what reasons should I call the Center for Pain Medicine after the injection?If you experience severe back pain, new numbness or weakness of your legs, or signs of infection in the area of the injection, you should call the office.

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