Facet Injections and Medial Branch Blocks to treat low back pain.

Facet arthropathy is arthritis of the small paired joints that are found on each level of our spine. When conservative treatments such as physical therapy, medication, and lifestyle modifications fail to provide adequate relief from low back pain, interventional pain management techniques may offer effective solutions. These minimally invasive procedures can target the facet joints directly, delivering medication to alleviate pain and reduce inflammation at the source, or indirectly by targeting the nerves that transmit pain signals from the painful area. A commonly used injection therapy for facet arthropathy is the facet joint steroid injection (image on right). During this procedure, a combination of local anesthetic and corticosteroid medication is injected into the affected facet joint(s) under fluoroscopic (X-ray) guidance. The anesthetic provides immediate pain relief, while the corticosteroid works to reduce inflammation and provide longer-lasting symptom relief. Facet joint injections can be performed in the cervical, thoracic, or lumbar spine, depending on the location of the pain.

Another injection therapy often utilized for facet arthropathy is the medial branch block. Unlike facet joint injections, which target the joints directly, medial branch blocks target the nerves that supply sensation to the facet joints. By blocking these nerves with a local anesthetic, medial branch blocks can temporarily interrupt the transmission of pain signals, providing short-term relief for patients with facet joint-related pain. These injections are meant to be diagnostic–they tell us how much of the pain is coming from the facet joints–and they are not expected to provide long-term relief. Patients who experience significant, temporary relief (generally lasting 2-24 hours) are candidates for radiofrequency ablation, a procedure that has the potential to provide several months to years of pain relief.

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Spinal Cord Stimulation

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What to Expect During Medial Branch Blocks or Facet Injections

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.

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.

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.