Facet Joint Injection and Medial Branch Block


 

A facet joint injection is an injection of a mixture of corticosteroid and local anesthetic into the facet joints, which help the bony spine flex and extend. A medial branch block is the numbing of the nerve that innervates the facet joint.

What is the purpose of it?

Sometimes when the tissue in the facet joints becomes inflamed and irritated, they cause pain with bending the back. The steroid reduces the inflammation of these tissues, which may help to reduce the pain.

How long does the injection take?

The length of the procedure depends on the number of joints that are going to be injected. It only takes a few minutes per joint injected once the procedure is started.

Will the injection hurt?

We first numb the skin and underlying tissues with a local anesthetic (numbing shot). After that, most patients only feel pressure as we insert a very thin needle into the facet joint. You may choose to receive intravenous sedation to make the procedure more tolerable.

Will I be "put out" for this procedure?

No. The safest way to do this procedure is under local anesthesia. You may choose to have intravenous sedation, which will help you relax, but you will always be awake during the procedure to minimize the chance of any nerve damage.

How is the injection performed?

You will be lying on your stomach for lumbar facet joints or lying on your back for cervical facet joints on an x-ray table. You will be monitored with a blood pressure cuff, EKG, and pulse oximetry. When the injection is complete, you will move to a recovery bed lying on your back.

What should I expect after the injection?

Due to the local anesthetic, you may feel better immediately after the injection. This usually only lasts a few hours until the local anesthetic wears off. You may have a sore back for a few days because of the needle insertion as well as the chemical irritation of the corticosteroid. The steroid should start providing pain relief by the 5th day after the injection.

What should I do after the procedure?

We require that you always have someone to take you home after the procedure because of the numbing medicine and/or the intravenous sedation given. You may apply ice to the injection site for the first day to help decrease swelling or aching. You should take it easy the day of the injection and after that, you may perform activities as tolerated.

Can I go to work the next day?

Unless otherwise directed by your physician, you may return to work the next day. Some patients may have a sore back for up to 3 days which can be alleviated with ice and ibuprofen.

How long will the effect of the medication last?

The local anesthetic usually begins working within minutes after the injection and typically lasts for several hours. The corticosteroid starts working in about 5 days and can last for weeks to months.

How many injections do I need?

You will follow up with your physician in two weeks after the injection. If you are still not relieved from your pain, it may be recommended to have a repeat injection. If you have partial benefit but still have residual pain, it may be recommended to have a third injection two weeks after the second.

Can I have more than 3 injections?

We generally limit the number of steroid injections in a 6-month period to 3 injections. If you are not getting lasting relief after 3 injections, it is unlikely that you would have prolonged relief with a fourth injection. We try to limit the amount of steroid given to you in a 6 month period to decrease the chance of side effects.

Side Effects | Risks

Overall, the procedure is very safe. As with any procedure, there are risks. The most common side effect is pain, which is temporary. Any time a needle is punctured through the skin, there is a chance of bleeding or infection that is very rare. Other rare side effects include spinal headache, nerve damage, worsening of pain, etc., which are extremely unlikely.

Who should not have these injections?

If you are allergic to corticosteroids, specific local anesthetics, or ionic contrast, please notify your physician. Also, if you are taking any blood thinners (Coumadin, Plavix, Warfarin, lovenox, Aspirin) please let your physician know ahead of time to help devise a safe plan for the injection.

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