Medial Nerve Branch Blocks/Facet Joint Injections

Pain Treatment Centers of America offers a variety of minimally invasive pain treatment procedures that we have perfected to help you achieve pain relief. Our treatments have been proven effective and are on the cutting edge of science related to pain reduction. Our goal is to improve every patient’s overall function and thus restore a better quality of life.

Facet joints are small joints located on the outside of the spinal column. These are synovial joints (much like the knee joint) and are responsible for the full motion in our spine. Without facet joints our movements would be very stiff and limited. Unfortunately these joints can often become inflamed or injured by processes such as whiplash injury, degeneration of the spine, arthritis in the spine or spinal surgery. Facet joints are found in the lumbar spine (lower back), thoracic spine (mid back) and cervical spine (neck). These joints are innervated by a very specific set of nerves – medial branch nerves. Medial branch nerves are responsible for the transmission of pain from these damaged facet joints. It is impossible to determine the exact origin of pain from physical exam and imaging studies such as CT scan or MRI. Sometimes a “diagnostic nerve block” is needed. A diagnostic nerve block is a procedure done to basically numb the nerve in question. Medial branch nerve blocks should take away at last 80% of the pain produced from damaged facet joints. This confirms the facet joint as a major source of your pain. These diagnostic nerve blocks vary in duration and may last anywhere from a few hours up to two weeks. Once the diagnostic nerve block wears off the pain will return back to pre-injection levels.

Please arrive 20 minutes prior to your appointment on procedure day. Our nurses will start an IV if you are requesting sedation and take a pre-operative nurse assessment. All patients are taken to the procedure room on a hospital bed. Once in the procedure room you will be given sedation to help make you comfortable. A cold cleaning solution will be placed on your skin to help decrease chances of infection. The procedure site is then identified by your doctor under x-ray guidance. Once the site is identified a tiny needle will be placed under continuous x-ray guidance onto the site of the medial branch nerve. A total of four needles are typically placed on each side. Needle placement is confirmed in both AP (up and down direction) as well as lateral (side to side direction) with contrast dye. A small amount of bupivicaine and steroid is administered to decrease inflammation around the nerve and basically “numb” the medial branch nerves. The same procedure will be repeated on both sides if pain is present. The needles are then simply removed and you will be transported back to the recovery room.

The steroid and bupivicaine will typically begin working within a few hours. It is important to remember – you have just been given an injection so you will have some injection site soreness and pain. However, you should feel at least 80% of your everyday pain in that area gone. These injections are called diagnostic injections. These will only last a few hours – some patient’s experience relief for up to two weeks – and then the pain will return.

Facet joint/medial branch injections have been performed for many decades, and are generally considered as a very safe and effective treatment for chronic pain conditions. Complications are rare, but could include allergic reaction, bleeding, infection, nerve damage, paralysis or ultimately death. If you get significant benefit from TWO diagnostic medial branch blocks then you will be a candidate for a more permanent pain relief procedure – medial branch rhizotomy. Medial branch rhizotomy (deadening of nerve) can last anywhere from 6 months to two years.