Facet Injections/Medial Branch Nerve Blocks/Radio-frequency
Each level of the spine is connected by facet joints. These facet joints are enervated (moved) by two small branches of the larger spinal nerves. Facet joints can be a significant source of pain, especially those with a history of trauma, degenerative disc disease, past spinal fusion, and/or advanced arthritis.
When other structures in the spine become weak, the facet joints often become hypertrophic or enlarged. Physical examination and imaging studies can delineate facet joint pain, but for a more definitive diagnosis and treatment, an injection is required. During a facet injection, anti-inflammatory corticosteroid and local anesthetic medication is injected directly into the facet joints to produce notable pain relief. This procedure is both therapeutic and diagnostic in intention. Should the patient feel relief from this injection, they are recommended for advancement to medial branch nerve blocks.
Medial Branch Nerve Blocks are injections of local anesthetic and anti-inflammatory corticosteroid near the nerves that enervate a particular facet joint. Typically several levels are injected at once: the affected level, and the levels above and below that enervate it. If dramatic (or greater than 50%) pain relief is achieved, then a secondary confirmation of the facet diagnosis is achieved. Patients who receive significant benefit from medial branch blocks will typically be recommended for advancement to radio-frequency/ablation of those same nerves.
Once the diagnosis is made and the painful levels identified, radio-frequency/ablation is performed. Radio-frequency is a relatively safe procedure that provides six to twelve months of pain relief. Heat disrupts the nerve’s ability to conduct painful signals. These nerves regenerate but it typically takes six to twelve months for this process to occur. A specialized needle is placed in a similar fashion to the prior medial branch blocks, and the area is tested with sensory and motor. Testing ensures that the cannula (needle) is far away from the large motor nerves of the spine. Once testing is completed, the area is anesthetized and the needle tips are heated to 60 – 80 degrees Celsius for 60 – 90 seconds, depending on the level being treated.
Side effects of Facet Joint Injections/Medial Branch Blocks/Radiofrequency are rare and your provider will discuss them with you prior to the procedure. You will be asked to sign a written consent prior to the procedure, as well as a brief medical history questionnaire. You will also be asked to refrain from taking any NSAIDs or other blood-thinning medications within three days of the procedure in order to prevent increased bruising.
Facet Joint Injections/Medial Branch Blocks/Radiofrequency, as with most other procedures, are performed in our fluoroscopy suite. X-ray, or fluoroscopy, is used for nearly all injections to ensure safety and accuracy. Intravenous sedation is typically not offered but a mild sedative may be utilized, depending on your medical condition.
SPECIAL NOTE POST-TREATMENT:
Should any anesthesia be administered, driving will not be possible directly after the procedure, and arrangements will need to be made by the client for transportation to and from the LifeLinc facility. Normal activities may be resumed the day after the procedure, unless the physician directs the client otherwise. It may take several weeks to experience the full amount of relief. A follow-up evaluation will be scheduled to monitor and access the results of the procedure.
Please contact our office with any additional questions about facet injections, medial branch nerve blocks, or radio-frequency.