Facet Injection / Medial Branch

Facet Joint Injection / Medial Branch Block

What are facet joints?

Facet joints link the bones of the spine together. Two facet joints are present at each spinal level.

What is the function of the facet joints?

The facet joints are important in allowing the spine to move.

Why do facet joints cause pain?

Facet joints are small joints with many nerve fibers; therefore, they are very pain sensitive.  The nerves that go to the facet joints are known as the Medial branch nerves. Trauma or arthritic changes can cause the release of pain generating substances in the joint that irritate these nerves.

What are some of the signs and symptoms of facet joint pain?

Facet joint pain originating in the lower back usually consists of pain or tenderness in the lower back slightly over one or both sides of the spine.  Low back pain will usually increase with bending backwards or twisting.  You may notice pain that radiates into the buttocks or thigh. Facet joint pain originating in the neck is similar to the lower back with the exception of the radiating pain, which usually involves the shoulder area, neck or headaches.

How do you determine if the Facet Joint is causing pain?

X-rays do not determine whether a facet joint is causing pain. However, x-rays are helpful in pointing out abnormalities such as osteoarthritis or other conditions that cause pain. A series of diagnostic blocks with anesthetic are the only way to reliably determine whether in fact the facet joints are a source of pain.

What is a facet joint block?

What a facet joint block involves is the injection of a substance into or next to the facet joint. Typically, in a diagnostic block, local anesthetic is used. In most cases a corticosteroid is also injected.  Radiographic control is mandatory in accurately and safely placing the needle. The purpose of facet joint blocks is twofold.  Initially, it is a diagnostic block.  If the patient receives 50% or greater pain relief for at least 2 hours, there is an increased likelihood that the facet joint is important in the patientís pain syndrome.  The block is then repeated to confirm the diagnosis. The second purpose of the facet block is to reduce pain.  Corticosteroids can help reduce the pain due to inflammatory substances that sensitize nerve endings.

Are facet joint blocks safe?

Yes, the risks of facet joint blocks are very low with the use of x-ray control.  Patients may experience some small amount of injection site tenderness.  This will usually resolve within several days. Risks such as headache, infection, or bleeding are extremely rare.

Do the injections hurt?

Patients undergoing facet joint injections all receive local anesthetic to anesthetize the skin and deeper tissues.

How long does it take for the injections to work?

Typically, the local anesthetic will work within 10 minutes.  The corticosteroid extends the duration of the block.  If the facet joint is found to be causing your pain, then a procedure known as Radio-frequency Ablation can be done to help the pain relief last longer.

When can I resume normal activities following the block?

Most patients can resume normal activity the next day.  In some cases, patients may require an additional day of rest.

What if I donít get any relief from the facet joint injections?

If you donít get relief from the facet joint injections, it is unlikely that this is a source of your pain.  You should then consider with your physician the other possible sources of your pain.

Will my insurance cover the cost of the  facet joint injections?

Insurance covers the cost of this procedure as long as it is considered medically necesary.  Our office will pre-certify the injection with your insurance company and inform you of what your portion will be before anything is done.  Payment arrangements may be made.

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