Facet Joint & Medial Branch Diagnostic Nerve Blocks

Serving the North Central Arkansas & South Central Missouri Communities

Located on the outside of the spinal columns, there are facet joints. These synovial joints allow us to have full motion of our spinal column. Out spinal movements would be extremely limited and stiff without them. Unfortunately, facet joints can frequently get injured or become inflamed by injuries sustained in whiplash, spinal degeneration, spinal arthritis, or surgery on the spine. These joints are found in the neck, mid-back, and lower back. Facet joints are interconnected to one another by medial branch nerves. These nerves transmit pain signals to the central nervous system from the injured facet joints. It is not possible to locate the source of discomfort by utilizing CT scans, MRIs, or physical exams. Oftentimes, a diagnostic nerve block is necessary. The diagnostic nerve block is a procedure whereby the injured facet joint is numbed to lessen the pain. This procedure should take away a majority of the pain from the injured facet joints. The lasting effects of the diagnostic nerve blocks vary from person to person, ranging anywhere from a few hours to a couple weeks. The effects will eventually wear off and the pain level may rise again to pre-injection levels.

Several medical conditions commonly treated by medial branch nerve blocks are:

  • Spondylosis: Degenerated facets joints caused by osteoarthritis
  • Cervicalgia: Pain in the neck area
  • Lumbago: Pain in the lower back area
  • Scoliosis: Spine is abnormally curved
  • Failed back surgery syndrome: Pain felt even after surgery was conducted on the spine

The Procedure

On the day of your scheduled procedure, please arrive at least 20 minutes early. Our highly trained nurses will begin an IV if you want to be sedated, and then conduct a nurse pre-operation assessment. You will be directed to lie down on a hospital bed in the procedure room. Once you are situated in the bed, you will be sedated and given nitrous oxide gas to induce comfort. We will place a cold cleaning solution on your skin to lessen the chance of infection. Then, using x-ray guidance, our doctor will identify the site of the procedure. Once we identify the site, we will place a small needle into the site of the medial branch nerve, still using x-ray guidance. There are usually a total of four needles placed into each side. We will confirm proper needle placement by utilizing dye to visually observe its effects. The medial branch nerves become less inflamed and are numbed by a combination of bupivacaine and steroids. The procedure is often repeated on both sides, if it is painful there too. Finally, we will remove the needles and direct you to a room for recovery.

What You Should Expect Afterwards

The combination of steroids and bupivacaine should start working within just a few hours. Since you have just been given an injection, it is normal to feel slight pain or soreness at the site of the injection. Fortunately, you should feel that a vast majority of the pain has lessened or even disappeared. These diagnostic injection’s effects will be felt from two hours up to a couple weeks.

Medial branch injections have been perfected over the past several decades and they are generally considered a safe and effective way to treat chronic pain in facet joints. Medical complications with the procedure are very rare, but the procedure could lead to allergic reactions, bleeding, damage of the nerves, infection, paralysis, and even death.

If you significantly benefit from two medial nerve block procedures, you will become a candidate for a longer-lasting pain relief procedure. This procedure is called a medial branch rhizotomy and its effects can last anywhere from six months all the up to two years.

For more information regarding this procedure, please call Interventional Pain Management, a department of BRMC, at (870) 508-5900.