Facet Joint Injections, Facet Medial Branch Nerve Block
The neck and back has many joints which work together to keeps the spine moving as one piece with a great deal of flexibility. These joint can get arthritic or inflamed and cause pain due to many reasons – normal wear and tear or trauma are the most common. Facet joint injections deliver medication directly into these irritated joints, where as medial branch nerve block delivers medication to the nerves that supply the sensation to these joints in an effort to decrease pain and inflammation while determining if this is the cause of a patient’s neck or back pain.
Facet joints are located in the neck, middle back (between the shoulders), and lower back. The nerves that provide innervation or sensation to these joints are called medial branch nerves and these are also located in the neck to the lower back. Either of these areas can be blocked to see if this is the patient’s pain generator.
During the procedure, the patient lies face down on the procedure table in a clean operating room. The patient’s vitals signs are collected and checked for appropriateness. The patient’s back, in the appropriate area, is cleaned with an antiseptic and draped using sterile technique. Using fluoroscopic (low dose x-ray) guidance, the area of interest is identified and the skin is anesthetized. Using a small needle, the joint or the nerve going to the joint is contacted using fluoroscopy. A solution of anesthetic and steroid, dependent on technique, is injected. It takes up to 20 minutes for the medication to take effect. The patient is asked to keep a pain journal for the next few days; the first five hours are the most important. The patient is reassessed the following week to determine the efficacy of the procedure. If the procedure has provided pain relief, then the patient may be scheduled for the second part of the procedure that involves ablating or disrupting this medial branch nerve. The disruption of this nerve which is described later under Advanced Procedures can provide pain relief up to six to nine months.