Facet Joint Injections and Medial Branch Blocks
This web page aims to give you a better understanding of these procedures. All procedures are a means to an end that is to improve function. Following facet joint blocks, your average pain score should decrease by 80% or more in the area treated. The duration of pain relief could be hours to weeks to months depending on whether it is diagnostic or therapeutic.
Why am I having this procedure?
Facet joints (also called zygapophyseal joints) are small joints of the spine that provide stability and help guide motion. They are found in the neck (cervical), upper back (thoracic) and lower back (lumbar). They can become painful as a result of arthritis, injury, or mechanical stress. However, this is not necessarily the sole cause of long term back pain.
Two nerves called “medial branches” supply each facet joint. These nerves carry pain signals to the spinal cord and these signals will eventually reach the brain.
The facet joints and/or medial branch nerves can be injected with a local anaesthetic and/or steroid. There are two reasons for doing this:
- Diagnosis: If the local anesthetic in the injection relieves your pain then it suggests that the facet joints are a source of your pain. Repeating the procedure a second time improves accuracy of the diagnosis. This can guide future treatment such as “radiofrequency ablation” of medial branch nerves, which can provide 6-12 months of relief. There is strong scientific evidence to support this.
- Therapy: The steroid in the injection can reduce inflammation, reduce medial branch nerve sensitivity and provide long lasting pain relief. The duration of pain relief may vary from weeks to months. There is limited to moderate scientific evidence to support this. If relief is sufficient but temporary, then radiofrequency ablation if performed on the medial branch nerves for relief that
How do I prepare for the procedure?
Please advise staff if you are:
Taking blood thinners (especially warfarin and clopidogrel)
Pregnant (or any chance of you being pregnant).
Allergic to iodine, betadine, shellfish, local anesthetics, or steroids.
Unwell (especially if you have an infection)
Staff may advise you to:
Fast for 8 hours prior to the procedure
Take your usual medications (apart from those mentioned above)
Arrange for someone to accompany you home
What does the procedure involve?
After arriving and completing the necessary paperwork:
- You will be asked to change into a hospital gown
- A small cannula may be inserted into one of your veins.
- You may be given a mild sedative if you choose.
- Your heart rate and blood pressure will be monitored throughout the procedure.
- You will lie face down on an procedure table, the skin over the area to be injected is cleaned with an antiseptic solution, and the area is kept sterile.
- A local anesthetic is injected into your skin
- An light x-ray machine, called a fluoroscope, is used to guide a small needle onto the medial branch nerve.
- The local anesthetic and anti-inflammatory solution is injected.
- Multiple injections may be required.
The procedure usually takes 15 to 30 minutes, plus recovery time.
What happens after the procedure?
- You will be monitored in a recovery area until you are ready to go home (usually 20-40 minutes).
- It is preferable to have someone take you home and stay with you for the next 24 hours.
- If you have received any sedation during your procedure, the effects of these medications may last for up to 24 hours. You may not remember some of the information given during the procedure. This is a normal side effect of the medication. For the next 24 hours you should not drive a vehicle, drink alcohol, operate machinery, make important decisions, sign legal documents or travel unaccompanied.
- You will be asked to record your pain level in the area treated during the first 12 hours after the procedure to report to the doctor at your next consultation. Please remove the dressing the day after the procedure, when you next wash.
- The pain may return when the local anesthetic wears off. Some people experience an initial increase in pain and stiffness that may continue for several days. If necessary, an ice pack can be applied to the area, 20 minutes at a time, for 1-2 days following the procedure.
- If steroids are injected then it may take several days for the benefits to be noticed. Additionally, you may feel flushed in the face and/or notice a change in your mood for a few days. Diabetic patients may notice a rise in their blood sugar levels.
- After the procedure, care must be taken to avoid a rapid increase in your activities. Gradually increase your daily activities as tolerated. Discuss this with your doctor.
- If you notice any swelling or bleeding from the site or have any other concerns, please contact the office, your Primary Care Physician, or the Emergency Department of your local hospital.
What are the risks of the procedure?
All invasive procedures carry the risk of complications. In general the risk is very low, but includes:
- Discomfort at the site of the injection
- Worsening of your pain (usually a temporary “pressure effect” from the injection)
- Allergic reaction to the medications
- Nerve damage (due to direct trauma, the medication, infection or bleeding)
- Steroid-related side effects such as transient flushing, mood swings, menstrual changes, and increased blood sugar (especially in diabetic patients).
What’s the deal with cortisone and steroids?
Cortisone, and other steroidal anti-inflammatory medications like it, have been used for decades to reduce the body’s production of inflammatory molecules when those molecules no longer help the body solve a problem but instead begin to attack and change the body. Unregulated or continuously produced inflammation from an area of injury or dysfunction can result in arthritis, scar tissue, and nerve irritation, to name a few. These powerful anti-inflammatory medications can have greater side effects on the body when taken by mouth since a relatively large dose is required to treat a small area of the body. There is some concern that repeated use of steroid shots may cause deterioration of the cartilage, bone or tendons. Therefore injections of a particular type and location are typically limited to six times per year when steroids are used.
Is there an alternative to using steroids?
YES! New data suggests that injection with local anesthetics alone may be as effective as with steroidal anti-inflammatories. However, further research must be done. Additionally, in our practice, we also use the natural, plant-based anti-inflammatory agent called Sarapin in all of our injections. Even if the steroid is eliminated there is still some potential anti-inflammatory benefit from the Sarapin, although this has not been as widely studied and accepted as the use of steroids.