Facet Joint Disease
Facet joint and medial branch blocks are used for patients with pain stemming from inflammation or irritation of the facet joints. These patients normally do not respond to other conservative means, such as oral anti-inflammatory medication, rest, or physical therapy. These procedures usually are performed for management of severe acute or chronic pain affecting the back or neck. They may also be performed for testing purposes by providing valuable diagnostic information about your condition.
A facet block is an injection of local anesthetic and steroid into the facet joint in the spine. A medial branch block is similar but the medication is placed outside of the joint near the nerves that supply the joint called the medial branch.
The Joint and Nerve
Facet joints are located between each vertebra and provide flexibility to the spine that allows you to bend and twist your back. The nerve supplying the joint is called a medial branch.
Each vertebra has two sets of facet joints, one facing upward (superior articular facet) and one downward (inferior articular facet) on each side (right and left). These joints act like hinges linking the vertebra together to form your spine. In order for the facets to be an effective hinge, each cartilage-coated joint is surrounded by a capsule of connective tissue and fluid that lubricates the joint allowing them to smoothly glide against each other.
Based upon your symptoms and/or the imaging of your spine, the injection can be directed into the facet joint or can target the nerves close to the joint, thus, a facet joint block or facet joint nerve block, called a medial branch block.
The procedure is done with you lying on your stomach in such a way that Dr. Dibble can best visualize the nerves supplying the joints in the neck, mid back or low back using X-ray guidance. After cleaning the skin and placing sterile drapes, Dr. Dibble numbs a small area of skin. Most people say the sting or burn of the numbing medicine is the most uncomfortable part of the procedure, although every person’s response to any procedure may vary.
Using X-ray guidance, Dr. Dibble will then guide a small needle to either the joint or the medial branch. In confirming the correct needle placement, the injection may initially create a response, which could be identical to the pain under investigation, similar but not identical, or a different or new sensation. After your response is recorded, the medication is then introduced around the facet joint or near the nerves supplying the joint.
You will be asked to rest for a short recovery period. Your blood pressure will be checked and you will be monitored for any complications or side effects. After authorization from Dr. Dibble, you may leave with your ride.
These blocks can provide pain relief that lasts from days to years. If you get good, lasting benefit from the injections, the procedure may be repeated. If you get good, short-term benefit, you could be considered for another procedure called facet rhizotomy (radiofrequency lesioning), which may provide longer-term relief of months to years. If you do not get any benefit from the procedure, the block still has diagnostic value in that it means that the pain is likely not coming from the targeted facet joints.
Rest today except for physical therapy or chiropractic treatment coordinated through Dr. Dibble. Tomorrow you may resume your normal activity (e.g. work and school). Nothing strenuous. Avoid activity that causes pain or discomfort.
Your legs may feel shaky or weak today; this is temporary and will wear off. We strongly suggest a responsible adult be with you for the rest of the day for your own safety.
Do not drive, operate heavy machinery, or use power tools.
Some short-term side effects may occur such as increased pain for a few days after the injection, including localized pain at the injection site. If you have soreness and discomfort at the injection site, you may use ice for the first 24 hours. Then use heat or ice (whichever is more comfortable for you) for 20 minutes at a time, 3-5 times a day for your comfort.
Diabetics may have short-term elevation of blood sugars. People prone to fluid retention may have increased fluid retention for 1-2 weeks.
DO NOT eat or drink anything for six hours prior to the procedure. You may continue to take your medicines with a sip of water.
If you are taking any anti-inflammatory medications, please stop taking them 5 days prior to the procedure. Please let Dr. Dibble know if you feel the need to take an alternative medication.
If you are taking any aspirin, please stop taking it 7 days prior to the procedure.
Please advise Dr. Dibble if you are on a blood thinner such as coumadin or if you are allergic to iodine.
Note: You must have someone drive you to your appointment or you may not be able to have the procedure that day. You must be discharged to an adult for your own safety. The entire procedure takes about an hour. The injection itself usually lasts about 10-15 minutes, and you will be asked to lie quietly for another 30 minutes for observation before being discharged. The numbing shot usually is the worst part of the procedure. There may be other discomfort involved, but it is more pressure than pain. Wear loose, comfortable clothing. For cervical procedures, you will be removing your shirt; for lumbar procedures, sweats are recommended. Keep in mind that iodine may stain your clothing.