Facet and Medial Branch Blocks

Facet and Medial Branch Blocks in Denver Colorado


Facet joints are tiny joints along the posterior outside of the spinal column. These synovial joints (like the knee joint) are responsible for spinal motion. Without these joints, movement is limited.


What is a facet joint?


The facet joints are tiny structures along the posterior spine. These joints allow the vertebrae to move slightly and provide support and stability to the spine. Clinical studies show that facet joint pain is around 50% of all back and neck pain reported by patients. Chronic injuries to these joints can lead to scoliosis and facet joint arthritis.


How so I prepare for the facet joint injection?


Before the facet joint injection procedure, you will meet with the doctor. During the consultation, the doctor evaluates your condition, conducts a physical examination, and orders some diagnostic tests.


Why is the facet joint injection done?


The facet joints become inflamed and/or injured through such process as whiplash, arthritis of the spine, degenerative spine disease, neck pain (cervicalgia), scoliosis, spondylosis, and spinal surgery. These joints are supplied by the medial branch nerves, which transmit pain from the back region. To determine if these joints are injured or damaged, the doctor will use imaging scans or a diagnostic nerve block. If pain relief is achieved using this block, then the doctor will consider radiofrequency ablation of the affected medial branch nerves.


How is the procedure performed?


Once you arrive at the surgical center, a nurse will have you change into a hospital gown and place an IV catheter in your arm. After being moved to a procedure table, you are given a sedative to make you comfortable. An anesthetic is used to clean the skin and lower chance of infection. The doctor inserts the procedure needle into the joint using x-ray guidance (fluoroscopy). A small amount of an anesthetic and corticosteroid is injected onto the nerves, which numbs the medial branch. The same injection is then repeated on both sides, so pain is resolved. After needle is removed, a bandage is applied.


What to expect after the facet joint injection procedure?


The anesthetic begins working within minutes of the injection. The corticosteroid will start working to relieve nerve inflammation after 3-5 days. You will notice some slight soreness at the injection site. Arrange to have someone drive you home, as the sedative will make you groggy. We recommend resting for a few days, and gradually returning to activities as tolerated.


Will a facet joint injection last long-term?


A facet joint block only provides 1-2 months of pain relief. If you have significant benefit following this injection, you can have a medial branch rhizotomy. The pain relief from deadening the medial branch nerves will last from 6-12 months.


What are the risks associated with the medial branch block?


The medial branch block is used to alleviate back and neck pain. The risks are rare, and include blood vessel injury, nerve damage, bleeding, and infection. However, only 0.5% of people will actually have a problem after this procedure, as it is safe and effective.


Do facet joint injections work?


In a recent randomized controlled study, researchers evaluated the clinical effectiveness of therapeutic lumbar facet joint injections. They found that outcome measures showed significant improvement in pain relief and functional status. The pain relief was found to last for up to 104 weeks, and this involved around 5 treatment sessions.


Kim D, Choi D, Kim C, Kim J, Choi Y. Transverse process and needles of medial branch block to facet joint as landmarks for ultrasound-guided selective nerve root block. Clinics in orthopedic surgery. 2013;5(1):44-48.

Lee HI, Park YS, Cho TG, Park SW, Kwon JT, Kim YB. Transient adverse neurologic effects of spinal pain blocks. Journal of Korean Neurosurgical Society. 2012;52(3):228-233.

Manchikanti L, Singh V, Falco FJE, et al. (2010). Evaluation of Lumbar Facet Joint Nerve Blocks in Managing Chronic Low Back Pain: A Randomized, Double-Blind, Controlled Trial with a 2-Year Follow-Up. Int J Med Sci, 7(3), 124-135.

Verrills P, Mitchell B, Vivian D, Nowesenitz G, Lovell B, Sinclair C. The incidence of intravascular penetration in medial branch blocks: cervical, thoracic, and lumbar spines. Spine. 2008;33(6):E174-177.