Facet Joint

What is a facet joint?

The facet joints link the vertebrae together and give them the flexibility to move against each other. There are two facet joints between each pair of vertebrae, one on each side. They extend and overlap each other to form a joint between the neighboring vertebra facet joint. The facet joints enable bending and twisting movements of the spine.

What is a medial branch nerve?

The medial branch is the branch of the spinal nerve that carries sensation and pain signals from the facet joint back to the spinal cord.

How do the facet joints cause pain?

The facet joints are just like any other joint in the body, they are susceptible to acute injury (sprain or strain) as well as degenerative arthritis. In the neck, the facet joints may cause neck pain, shoulder pain, and headaches. The pain is especially bad when trying to look up or turn your head.

What are the indications for a facet joint injection or medial branch block?

These injections are performed as a diagnostic test when it is thought that a facet joint or joints is part of the process that is causing the pain. A small amount of a local anesthetic is injected into the joint or over the medial branch nerve to see if this will temporarily relieve your back pain.

How long will the pain relief last?

The local anesthetic block will only last a few hours. A small amount of steroid may be injected along with the local anesthetic and may provide pain relief from days to months.

How do I prepare for the procedure?

These injections are a minor surgical procedure that is typically performed in the physician’s office or an ambulatory surgery center. You should not eat or drink anything for at least 2 hours before your procedure. You should take all of your medicines except blood thinners the day of your procedure.

What should I expect during the procedure?

You will be lying face-up on an X-ray table during the procedure. Live X-rays (called fluoroscopy) will then be taken to ensure proper positioning. Your neck will then be cleaned with an antiseptic solution and a sterile drape will be placed over this area to keep it clean for the procedure. A local anesthetic will then be injected into your skin to make it numb. A needle will then be inserted though the numbed skin and slowly advanced into the facet joint (or close to the medial branch nerve) using fluoroscopy (live X-rays) to guide the needle. When the needle enters the facet joint (or close to the medial branch nerve), it is common to feel a slight increase in your pain level. The local anesthetic (with or without steroid) will then be injected. Once the injection is complete, the needle will be withdrawn and a dressing will be placed over the injection site.

Can I have sedation for the procedure?

The vast majority of patients do not require sedation for the procedure, however, we will provide light sedation for the procedure at your request. Patients who are receiving sedation must have a responsible adult with them to drive them home.

How soon can I go home after the procedure?

Your blood pressure, pulse, and breathing will be checked frequently over the next 15 to 20 minutes. Once your vital signs are stable, you will be able to go home.

Can I drive myself or do I need a ride?

Most patients prefer to have a family member or friend drive them for their procedure, however, you may drive yourself to the procedure as long as you are not requesting sedation.

Can the procedure make my pain worse?

Some patients will experience mild pain with the procedure that will ease up in a very short amount of time. On rare occasions, patients have experienced a prolonged increase in pain after the procedure.

What if the procedure does not improve my pain?

Facet joint injections or medial branch blocks are performed to diagnose pain being caused by the facet joints in your neck and will not relieve pain caused by intervertebral discs, spinal nerves, or muscles, which can continue to cause pain after the procedure. If your pain is not relieved after the procedure, the facet joints have been ruled out as the source of your pain.

What if the injection is successful?

If the injections successfully treat your pain, then you will likely be scheduled for radiofrequency ablation (RFA) of the medial branch nerves.

Are there any restrictions following the procedure?

We ask that you not immerse in water for 24 hours after the steroid injection. This means that you can shower, but not take a bath or go swimming for the rest of the day. There are no other specific restrictions on activity however, we recommend that you “take it easy” the rest of the day and slowly resume your normal activities.

What are the risks of the procedure?

Overall, facet joint injections (and medial branch blocks) are a very safe procedure. Serious side effects or complications are rare, however, like all injection procedures, possible adverse effects are possible. The most common complications include bleeding and bruising at the needle puncture site, post-procedure headaches, and lightheadedness or dizziness immediately following the procedure. Other very rare complications include transient numbness or weakness, paralysis (partial or complete), contrast or allergic reactions, sexual dysfunction, and death. If you experience any concerning symptoms after your injection, you should call your doctor immediately or go to an emergency room for evaluation.

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