A block (or local anesthetic injection) that is performed to confirm that a facet joint is the source of pain and decrease pain and inflammation in a facet joint or joints.
Actually this is the only true way to diagnose Facet Joint Syndrome, as an abnormal looking joint on X-ray or CT scan, may be painless, and vice versa a normal looking joint may be the pain generator.
The patient is given the option of light, (or deep in rare cases) IV sedation under monitoring of the EKG, pulse oximeter, etc. by a Board Certified Anesthesiologist. A tiny needle (smaller than the size of a paper clip) is then inserted into the area of the facet joint where the nerve reaches it (or directly inside the facet capsule, in some cases) and the physician injects an anesthetic and steroid.
This is done under fluoroscopy. I usually do the first one with a short acting local to quickly diagnose the levels of facet injury involved.
Decrease in or relief of back pain. More importantly confirmation of the diagnosis, with the allowance of rational treatment.
EXPECTED PROCEDURE TIME
Fifteen to Thirty minutes, depending on the number of levels performed.
Note injections may be done in conjunction with massage, myo-fascial release, or “light” physical therapy especially ultrasound and stimulation. Chiropracty will universally aggravate Facet Joint Syndrome and must be avoided at all costs.
Probably the easiest of all interventional procedures (provided done by a Board Certified physician with experience), with the lowest risk and most benefits.
Once, the diagnosis is made by a prognostic block, the block may be repeated with a longer acting local and depot steroid preparation. Some milder cases may be treated, by improving posture, spine bracing during lifting/exercise and anti-arthritic agents such as Motrin or the newer (Cox-2) inhibitors such as Celebrex or Vioxx. If the pain recurs, pulsed radiofrequency is the definitive treatment (see inside).
FACET JOINT SYNDROME (Definition):
A constellation of symptoms which result in diffuse pains that do not fit a clear nerve root pattern (e.g. not sciatica), these pains are worsened with movement of the spine, poor posture, often sleep, sometimes associated with cold burning sensations, usually worsened by cold damp weather and are now known to emanate from the tiny medial branch nerves that supply the facet joint.
REMEMBER, THE ONLY WAY TO DEFINITIVELY MAKE THE DIAGNOSIS IS BY A DIAGNOSTIC/PROGNOSTIC FACET BLOCK
Please click on these links to learn more about the options you have for pain management:
- Radiofrequency Ablation
- Epidural Anesthetic Block And Steroid Injection
- Selective Nerve Root Block (SNRB)
- Facet Block
- Costovertebral Joint Block
- Sympathetic Nerve Block
- Stellate Ganglion Block (Cervical Sympathetic Block)
- Medial Branch Rhizotomy
- Medial Branch Rhizotomy With Pulsed Radiofrequency