Facet Joint Injections / Medial Branch Blocks / Radiofrequency
Each level of the spine is connected to its neighboring level by a facet joint. Each facet joint is fed by two small branches of the larger spinal nerves. Facet joints can be a significant source of pain in several types of patients, especially those with a history of trauma, degenerative disc disease, 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 suggest a diagnosis of facet joint pain, but for a more definitive diagnosis and treatment, an injection may be required. Anti-inflammatory steroid and local anesthetic can be injected directly into the facet joints to produce dramatic pain relief. This procedure can be repeated several times a year. If an injection directly into the joint does not provide sustained relief, or your medical history precludes repeated steroid injections, a medial branch block can be performed.
A medial branch block is an injection of local anesthetic near the two small nerves that feed a particular facet joint. Typically several levels are injected at once. If dramatic (or greater than 50%) pain relief occurs while the local anesthetic is active (typically several hours), then a diagnosis of facet joint pain can be made. A second confirmatory test may be required.
Once the diagnosis is made and the painful levels identified, radiofrequency ablation can be performed. Radiofrequency is a relatively safe procedure that provides six to 12 months of pain relief. Heat disrupts a nerve’s ability to conduct painful signals. Nerves regenerate but it takes six to 12 months for this to occur. An insulated needle is placed near the appropriate medial branch nerve and the area is tested. Testing ensures that the needle is far away from the large motor nerves of the spine that are responsible for strength. Once testing is completed, the area is anesthetized and heated to 60 – 80 degrees Celsius for 60 – 90 seconds, depending on the level being treated. Lower temperatures and shorter lesion times are typically used in the cervical spine.
Side effects of Facet Joint Injections/Medial Branch Blocks/Radiofrequency are rare and your physician will discuss them with you. You will be asked to sign a written consent prior to the procedure. Please make sure you fully understand the risks and benefits of any procedure prior to signing the consent form.
All the above procedures are performed in our in-office fluoroscopy suite. X-ray is used for all facet joint injections, medial branch blocks, and radiofrequency procedures. Intravenous sedation is typically not offered but a mild oral sedative may be offered, depending on your medical condition. You will not be able to drive following this procedure, so please make arrangements for transportation. You may resume normal activities the day after the procedure, unless otherwise directed by your physician. It may take a week or more for you to feel relief after a facet joint injection.
Because of the diagnostic nature of a medial branch block, pain relief may start immediately but last only a few hours. Several weeks may be required to feel the full effect of a radiofrequency ablation procedure. Typically a follow-up evaluation is scheduled two weeks from the date of the procedure, so that you can discuss your response to the injection with your physician.
Facet joint injections, medial branch blocks, and radiofrequency ablation are relatively safe and common techniques that can provide dramatic and long-lasting pain relief. Please contact our office if you have additional questions regarding these procedures.
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Side effects of Facet Joint Injections/Medial Branch Blocks/Radiofrequency
Side effects are rare, but fluid retention, insomnia, elevated blood sugar, bleeding, and infection have occurred. These side effects usually occur on patients taking strong anti-coagulants or blood thinners, or those with a high fever or an active infection. Diabetic patients will need to monitor their blood sugar before and after the procedure as steroid can cause blood sugar to rise. As long as a diabetic patient’s blood sugar is normal before the procedure and monitored after the procedure, the risk of a dangerously high blood sugar is low. Sometimes a patient recovering from a radiofrequency procedure can experience a burning sensation in the area treated for several weeks after the procedure. Nerves that have been heated to high temperatures can take several weeks to recover. This condition is temporary. Other less common risks include increased pain, kidney failure, bowel or bladder dysfunction, paralysis, and death. Your physician should be notified if you are taking medications such as Coumadin, Plavix, Ticlid, Lovenox, Aggrenox, Insulin, or Metformin. Your physician should also be made aware of any allergies you have, especially if you are allergic to iodine or contrast. Notify your physician immediately if you have concerns about your condition after the procedure.
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