Facet Joint Injections

Facet joints are innervated or ‘supplied’ by nerves called ‘medial branches.’ These nerves carry the pain signals from the facet joints to the brain. A medial branch block places a local anesthetic and steroid along these nerves to block pain signals from the facet joints.

These injections are typically ordered for patients who have pain primarily in their back coming from arthritic changes in the facet joints. These injections can serve a diagnostic role by identifying whether a patient’s pain is coming from the joints of the back. If injection of an anesthetic medication into the facet joints or along the medial branches causes the back pain to go away, then the injection was diagnostic in identifying the source of the patient’s back pain. If the steroid medication injected provides long-term benefits, then the injection served a therapeutic role. If only short-term improvement is seen with facet or medical branch injections the patient then may benefit from radiofrequency ablation of the medial branches.

Typically, facet joint and medial branch blocks take a few minutes to perform, from 5-10 minutes, but expect to spend 45 minutes to an hour at our facility dues to preparation and evaluation time. For radiofrequency oblation, the procedure time is approximately one hour. You must have someone drive you home. We advise patients to take it easy for the remainder of the day and resume regular activities as tolerated the next day.

With all injections, there is a risk of infection, bleeding, temporary increase in pain and injury to the structures along the course of the needle. Through sterile equipment and technique, we minimize the risk of infection. The risk of bleeding is minimized by discontinuation of blood thinners (this typically require approval from prescribing doctor) and non-steroidal anti-inflammatories (except Celebrex). By using X-ray guidance (fluoroscopy) we minimize risk of tissue injury to structures along the course of the needle. Nerve irritation is minimized by the use of local anesthetic to provide temporary relief that typically wears off after 3-6 hours. The steroid medication can take 3-5 days to take full effect, so patients may experience increased soreness for a couple days after the procedure. For radiofrequency ablation, there is a risk of nerve damage from lesioning other nerves; to minimize this risk, sensory and motor stimulation are performed to insure placement of the probe is along the medial branch and is not coming into contact with other nerves. If you have an active infection or are unable to stop blood thinners then you may not be a candidate for these types of injections.