Facet Injections, Medial Branch Blocks & Ablations

Facet Injections, Medial Branch Blocks & Ablations

Facet-Injections-Medial-Ablations

Facet joints are small joints located between the vertebras in the spine.  There are two facet joints at each level of the vertebra – providing stability to the spinal column, as well as the flexibility needed to walk, run, bend, sit and twist. When a joint is damaged, it may become swollen, painful and stiff. Common causes of facet joint pain, or facet joint syndrome, include arthritis, degenerative disease of the spine and trauma (accident or injury).  At Texas Comprehensive Spine Center, we employ a variety of minimally-invasive, non-surgical treatment modalities designed to relieve facet joint pain. These treatment methods include facet injections, medial branch nerve blocks and ablations.

Facet Injections

What It Is:

A facet joint injection combines a local anesthetic and a corticosteroid anti-inflammatory medication that is injected into the facet joint(s) of the spine. It is a procedure to help diagnose the source of the patient’s pain, as well as help relieve pain and inflammation.

What To Expect:

In preparation for the facet joint procedure, the skin and tissue above the facet joint is numbed with an injection of local anesthetic. Using an X-Ray device, called a fluoroscope, the physician guides a small spinal needle into the joint and injects a numbing anesthetic and anti-inflammatory steroid medication. If this causes the pain to subside, it suggests that the facet joint injected was the source of the pain. As this anesthetic wears off, pain may return. The steroid medication will take effect within days after the treatment.  The procedure takes 10-20 minutes and is followed by a brief observed recovery time before discharge.

Medial Branch Blocks

Facet joints along the spine are connected to two medial branch nerves used to carry signals (including pain signals) away from the spine to the brain. Medial branch blocks are performed to disrupt pain signals from the medial branch nerves. This procedure can be performed independently to provide long-term back pain relief. It is also used as a two-step diagnostic and treatment approach prior to a radiofrequency ablation to identify the specific facet joint(s) causing pain.

What It Is:

A medial branch block is a non-invasive procedure where an anesthetic agent is injected near a targeted medial nerve to interrupt the sensory nerve supply to the inflamed facet joint.

What To Expect:

After a local skin anesthetic is applied, the physician uses fluoroscopy (X-Ray) guidance to direct a small needle along the nerves that supply the inflamed joint. A small amount of contrast dye may be injected to confirm that the medicine covers the medial branch nerve. Once confirmed, the numbing medicine (anesthetic) is slowly injected on the targeted nerve.  Several levels of the spine can be injected in one procedure.  The entire procedure usually takes between 15 -30 minutes and is followed by a brief observed recovery time before discharge.

Radiofrequency Ablation Procedure

A radiofrequency ablation (RFA), sometimes referred to as a radiofrequency neurotomy or rhizotomy, reduces or eliminates the pain of damaged facet joints by disrupting the medial branch nerves that carry the pain signals to the brain. In cases where the medial branch block proves which nerves are transmitting the patient’s pain; a radiofrequency ablation procedure can be considered for longer term pain relief.

What It Is:

A minimally-invasive procedure, a radiofrequency ablation (RFA) is a type of injection procedure where a heat lesion is created on the nerve that transmits the pain signal to the brain. The goal of this procedure is to interrupt the sensory nerve supply of the involved facet joint while preserving normal sensation and muscle strength.

What To Expect:

The procedure is performed with local anesthetic and mild sedation.  The physician uses fluoroscopy (X-Ray) guidance to place special radiofrequency needles alongside the nerves that supply the inflamed joint. After testing to ensure that the needle is in the correct position, thermal energy is applied – cauterizing the nerve.  The procedure is performed on an outpatient basis and typically requires 30 minutes and is followed by a brief observed recovery time before discharge.