FACET JOINT BLOCK

Facet Joint Block

Southwest Scoliosis and Spine Institute’s board-certified, fellowship-trained orthopedic physicians: Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD, have years of experience treating thousands of patients with complex spine conditions. In order to learn what is causing your pain, the doctor may utilize a few different tests.  Also, the treatment plan will always start with a conservative plan — like a facet block.

For your information, the facet block procedure consists of a local anesthetic and steroid.  And then this combination is injected directly into the suspected source of the pain. For example, this injection will hopefully reduce the inflammation in the joint space of the spine.

What is Facet Block

The facet joint block consists of both a test and a type of treatment.  First, the doctor injects lidocaine or Novocain into the facet joint or the small nerve branches going to the facet joint.  As an example, a dentist uses the same medication to numb your jaw or a doctor to sew up a laceration. Upon injection, the lidocaine numbs the area around the facet joint.  If your pain goes away, the doctor can assume that the facet joint contributes to the problem.

Why Use a Facet Block?

Like other joints in the body, facet joints can cause pain when irritated or inflamed. Upon treating the facet joint, the block provides a “therapeutic trial.” For instance, this means that when completed, it should relieve your symptoms if the problem comes from the structure being treated. For example, medication injected into the joint during a facet joint block should numb the spot and remove the pain. Cortisone, a steroid, decreases inflammation in the joint and gives temporary relief for several weeks or months. 

Implementing a Facet Block

You will receive medication to help you relax, along with a local anesthetic around the injection area on the back. Then the doctor will insert a long needle into the center of the facet joint or next to the small nerve branches that go to the joint.  The doctor watches on a fluoroscope as the needle gets inserted to make sure it goes to the right spot. The fluoroscope is a special X-ray that allows the doctor to see the spine and needle as it moves. Once the needle enters the facet joint or next to the nerve branch, a combination of anesthetic and cortisone gets injected.

Limitations of a Facet Block

A facet joint block only shows how your symptoms react to the injection. It does not involve taking any pictures, except to make sure the needle is placed in the right spot. It does not give specific information about the nerves or discs.

Risks of a Facet Block

This test has more risks than most because a needle inserts medicine into a facet joint. Therefore, the risks include infection of the joint and an allergic reaction to the injected medication. Normally, doctors generally prefer to use “noninvasive” tests first, such as the MRI and CT scan. Finally, these tests, along with facet blocks, help doctors clarify the diagnosis and choose the best way to treat the problem.