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 the cause of the patient’s 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. This combination gets injected directly into the suspected source of the pain. In this case, the injection will hopefully reduce the inflammation in the joint space of the spine.

Facet joint block, also known as facet joint injection or medial branch block, is a minimally invasive procedure.  Our doctors commonly use this procedure to diagnose and treat pain originating from the facet joints in the spine. This webpage provides a detailed overview of the facet joint block procedure.  It includes the conditions that warrant its implementation, the method of administration, and the expected duration of pain relief.

Indications for Facet Joint Block

Facet joint blocks are typically recommended for individuals experiencing persistent pain in the spine, specifically in the facet joints. The facet joints are small joints located between the vertebrae. The provide stability and movement of the spine. Conditions that may lead to facet joint pain and prompt a doctor to consider a facet joint block include:

• Facet Joint Arthritis: Also known as facet joint osteoarthritis, involves the degeneration of the facet joints.  The cause is usually due to wear and tear, leading to inflammation, stiffness, and chronic pain.
• Facet Joint Syndrome: This refers to pain and dysfunction in the facet joints caused by injury, repetitive strain, or stress on the spine.
• Facet Joint Sprain: Sports injuries or car accidents can result in significant pain and limited mobility by spraining or straining facet joints.
• Facet Joint Degeneration: When facet joints degenerate and bone spurs form, chronic pain can occur along with reduced spinal mobility.
• Facet Joint Block Procedure: The facet joint block procedure involves the following steps:

What Should I Tell My Doctor Before a Facet Joint Block Procedure?

Preparing for a facet joint block procedure involves sharing vital information with your healthcare provider to ensure safety and effectiveness. Here’s a concise guide on what to communicate to your doctor:

1. Pregnancy Status

• Inform them if there’s a possibility you might be pregnant. This information is crucial as it may influence the approach to your procedure.

2. Current Medications

• Provide a detailed list of all medications you are currently using. This includes over-the-counter drugs, prescription medicines, vitamins, and herbal supplements.

3. Blood Thinners and Pain Relievers

Specifically highlight if you are using blood-thinning medications such as:

• Warfarin (Coumadin)
• Heparin
• Lovenox
• Clopidogrel (Plavix)
• Common pain relievers like aspirin, ibuprofen, or naproxen

Your doctor may advise you to pause these medications for a few days before the procedure.

4. Allergies

Discuss any known allergies, especially:

• To anesthesia (local or general)
• To iodine-based contrast materials or other types of dyes

If allergic to contrast material, your doctor may prescribe steroids to reduce reaction risk, typically taken 12 hours before exposure.

5. Recent Illnesses or Medical Conditions

• Share any recent health issues or chronic conditions. This information helps in assessing the overall risk and taking necessary precautions.

6. Metal Items and Personal Belongings

• Remove and leave at home any metal items, including jewelry, hairpins, or dentures, as they could interfere with imaging tests. You might need to remove hearing aids, dental work, and underwire bras.

By thoroughly discussing these points with your doctor, you help create a safer and more effective procedure environment. Remember, clear communication is key to managing your health effectively.

What to Avoid Before a Facet Joint Block Procedure

Preparing for a facet joint block procedure involves some essential steps to ensure your safety and the effectiveness of the procedure. Here’s what you need to know about what to avoid:

Personal Items and Clothing

• Jewelry and Metal Accessories: Remove all jewelry, hearing aids, and any metal accessories, including body piercings and bras with metal underwire. Metal can interfere with imaging and should be left at home or removed upon arrival.

Dietary Restrictions

• Fasting: Refrain from eating or drinking for several hours before your appointment. This is crucial, especially if the procedure involves the use of contrast material, which assists in enhancing imaging results.

Medication and Allergies

• Inform Your Doctor: Be sure to notify your physician of all medications you are currently taking. Discuss any allergies or sensitivities you may have, particularly to contrast materials, which are sometimes used during the procedure.
• Allergy Precautions: If you have a known allergy to contrast dyes, your doctor may prescribe premedications, such as steroids, that need to be taken about 12 hours before the procedure to mitigate potential allergic reactions.

Clothing for the Procedure

• Procedure Attire: You will be required to change into a gown provided by the facility. Comfortable and easy-to-remove clothing will streamline this transition.

Following these guidelines will help ensure your procedure goes smoothly and without unnecessary complications. If you have specific concerns, consult with your healthcare provider in advance to discuss them.

Prior to the Procedure

Before the Facet Joint Block procedure, thorough preparation is crucial to ensure safety and effectiveness.

Medical and Medication Preparation

• Blood Testing: Your doctor may test your blood to confirm it clots normally.
• Medication Review: Inform your physician about all medications you’re taking, including herbal supplements. Disclose any allergies, particularly to local anesthetics, general anesthesia, or iodine contrast materials. You might need to temporarily stop taking aspirin, NSAIDs, or blood thinners like Warfarin, Heparin, Lovenox, and clopidogrel (Plavix) as advised by your doctor.
• Recent Illnesses: Discuss any recent illnesses or medical conditions with your doctor.

Day of the Procedure

• Eating and Drinking: Refrain from eating or drinking a few hours before the procedure, especially if contrast materials will be used. If you have a known allergy to contrast materials, your doctor may prescribe a steroid to mitigate allergic reactions. These medications should be taken 12 hours in advance.
• Items to Leave at Home: Remove metal objects such as jewelry, eyeglasses, and hairpins as they may interfere with CT images. Women should remove bras with metal underwire. If possible, remove piercings, dentures, and hearing aids.
• Pregnancy Notification: Women should inform their doctor if there’s any possibility of pregnancy.

What Does the Equipment for a Facet Joint Block Look Like?

Facet joint block procedures involve specialized medical equipment designed for precision and safety. Let’s explore the tools typically used:

• Needle: This is a fine, hollow needle that measures either 3.5 or 5 inches, chosen based on your body size to ensure accurate delivery of treatment.
• Imaging Guidance System: To accurately place the needle, doctors use either fluoroscopy or a CT (Computed Tomography) scanner.
• Fluoroscopy Unit: It resembles an x-ray device combined with a video screen. The system allows real-time imaging, so the doctor can view the procedure live on a monitor situated in the exam room.
• CT Scanner: This large machine features a central opening or short tunnel where you will lie on a flat, narrow table. The table slides into this tunnel, and the surrounding ring, known as a gantry, houses an x-ray tube and detectors. These rotate around you, capturing detailed images.

The technologist operates the CT scanner from a separate control room, where they monitor the images and maintain communication with you through a speaker and microphone, ensuring a smooth and comfortable experience.

Procedure Overview

The patient is positioned on an examination table, and the skin over the targeted facet joint is cleaned and sterilized.

• Local Anesthesia: A local anesthetic numbs the skin and underlying tissues at the injection site. This ensures minimal discomfort during the procedure.
• Fluoroscopic Guidance: A fluoroscopy, a real-time imaging technique, guides the placement of the needle into the facet joint.
• Injection Administration: A mixture of local anesthetic and anti-inflammatory medication, such as a corticosteroid, is injected into the facet joint. Doctors can also inject the medicine into the surrounding nerve branches (medial branches). This medication aims to alleviate pain, reduce inflammation, and provide diagnostic information.
• Post-Injection Observation: After the injection, the staff will monitor the patient for a short period to assess any immediate response or potential side effects.

How Frequently Can You Repeat a Facet Joint Block if It’s Effective?

A Facet Joint Block is a medical procedure used to relieve pain in the spine. If you find significant relief from your symptoms after the initial procedure, it can be repeated. Generally, an effective Facet Joint Block can be administered up to three times per year.

Here’s a quick breakdown:

• Initial Assessment: After the first successful treatment, consult with your healthcare provider to determine the necessity of additional blocks.
• Frequency: The procedure can be repeated a maximum of three times annually, ensuring that there is sufficient time between sessions to evaluate the long-term benefits and manage any potential side effects effectively.

Always discuss with your healthcare specialist to tailor a plan that best suits your needs and monitor the effectiveness of the treatments over time.

Potential Complications of a Facet Joint Block Procedure

Undergoing a Facet Joint Block procedure can involve several potential complications, though they are generally uncommon. Here’s a detailed look at what might occur:

• Infection Risk: Any procedure involving skin penetration has the potential for infection. Fortunately, the likelihood of an infection that necessitates antibiotic treatment is relatively low, estimated at fewer than one in 1,000 cases.
• Allergic Reactions: There is a possibility of experiencing allergic reactions to components used in the procedure, such as contrast materials, steroids, or local anesthetics. Severe or life-threatening allergies are rare, but milder reactions can still occur.
• Bleeding Concerns: Bleeding can be a complication, though it is considered rare. It’s more prevalent in patients who have bleeding disorders or those taking blood-thinning medications.
• Nerve and Spinal Cord Issues: Although uncommon, there is a potential risk for nerve damage or spinal cord injury. These complications can result from needle trauma or an infection after the procedure.
• Pregnancy Considerations: Women who are pregnant or suspect they might be should inform their healthcare provider prior to the procedure. This is an important step to ensure the safety of both the mother and the unborn child, considering potential exposure to radiation.

Understanding these risks helps in making informed decisions and preparing for any necessary precautions during the Facet Joint Block procedure.

Understanding the Risks of a Facet Joint Block

When considering a Facet Joint Block, it’s important to be aware of potential risks, despite their rarity. Here’s a breakdown of what you should know:

• Risk of Infection: Any skin penetration, including a Facet Joint Block, carries a slight risk for infection. The probability of needing antibiotics due to infection is quite low, estimated at less than one in 1,000.
• Allergic Reactions: There is a possibility of experiencing an allergic reaction to the substances used, such as the contrast dye, steroids, or local anesthetics. Severe allergic responses are uncommon, but it’s always wise to discuss potential allergies with your healthcare provider beforehand.
• Bleeding Concerns: While rare, bleeding can occur, particularly in individuals with bleeding disorders or those taking anticoagulants. It’s crucial to inform your physician about any conditions or medications that might increase this risk.
• Nerve or Spinal Cord Injury: Though extremely rare, there is a potential for nerve or spinal cord damage. This can happen due to needle trauma or subsequent infection.
• Pregnancy Precautions: Women should inform their doctor if there’s any chance they could be pregnant, as special precautions may be necessary due to radiation exposure. Always discuss any concerns about x-rays during pregnancy with your healthcare professional.

Being informed allows you to make decisions with confidence about your healthcare. Always communicate openly with your medical team about any concerns or questions regarding the procedure and its risks.

Special Considerations for Women Undergoing Facet Joint Block Procedures

When considering a Facet Joint Block procedure, women should be aware of a few important considerations:

• Pregnancy Status: It’s crucial for women to inform their healthcare provider and the medical team if there’s any chance they could be pregnant. Certain procedures and medications may pose risks during pregnancy, so full disclosure helps ensure safety and the most appropriate care.
• Radiation Exposure: Though not typically a concern for Facet Joint Block procedures, it’s essential to discuss any worries about radiation with your doctor. They can provide guidance on the safety measures in place to protect both patients and potential pregnancies.
• Menstrual Cycle Considerations: While not commonly impactful, some women may prefer to schedule procedures around their menstrual cycle for personal comfort. Discuss any preferences or concerns with your healthcare team.

By addressing these considerations, women can work with their healthcare professionals to ensure the safest and most effective treatment planning.

Patient Preparation

The patient is positioned on an examination table, and the skin over the targeted facet joint is cleaned and sterilized.

• Local Anesthesia: A local anesthetic numbs the skin and underlying tissues at the injection site. This ensures minimal discomfort during the procedure. You may feel a slight pin prick when the needle is inserted, but most of the sensation is concentrated on the skin.
• Fluoroscopic Guidance: A fluoroscopy, a real-time imaging technique, guides the placement of the needle into the facet joint. You will be asked to remain very still during this process, which may cause some pressure when the needle is inserted.
• Injection Administration: A mixture of local anesthetic and anti-inflammatory medication, such as a corticosteroid, is injected into the facet joint. Doctors can also inject the medicine into the surrounding nerve branches (medial branches). This medication aims to alleviate pain, reduce inflammation, and provide diagnostic information.
• Post-Injection Observation: After the injection, the staff will monitor the patient for a short period to assess any immediate response or potential side effects. You may feel sore at the area of the needle insertion for a few days. Applying ice or a cold pack to the injection site can help, and your doctor may prescribe pain relief medication if needed.

Post-Procedure Recommendations

• Transportation: Arrange for someone to drive you home after the procedure, as the effects of the medications may impair your ability to drive safely.

By following these preparation steps, you can help ensure a smooth and successful Facet Joint Block procedure.

• You should avoid strenuous activities and driving for 24 hours to prevent aggravating the treated area.
• Initially, you may notice an increase in pain as the numbing medicine wears off before the cortisone begins to take effect. Common side effects from the anti-inflammatory medication might include a feeling of warmth, fluid retention, or mood swings. It’s important to monitor these symptoms and inform your healthcare provider if they persist.

The duration of pain relief from a facet joint block can vary from person to person. It depends on factors such as the underlying condition being treated, the individual’s response to the medication, and the specific medications used. Typically, the effects of a facet joint block can be classified into two phases:

• Diagnostic Phase: Shortly after the procedure, if the facet joint block provides significant pain relief, it serves as a diagnostic tool to confirm that the facet joints are the source of the pain. The duration of pain relief during this diagnostic phase is relatively short, usually lasting a few hours to a day.
• Therapeutic Phase: The therapeutic effects of a facet joint block usually develop a few days after the procedure and can last for several weeks or months. The anti-inflammatory medication injected into the facet joint helps reduce inflammation, alleviate pain, and improve overall function.

If the facet joint block is effective in alleviating your pain, the procedure may be repeated up to three times a year, offering a sustainable approach to managing chronic pain.

It’s important to note that the duration of pain relief is variable, and individuals may experience varying degrees of relief based on their unique circumstances. If the facet joint block provides significant and long-lasting pain relief, it may indicate the potential benefits of further treatments, such as radiofrequency ablation, to provide more extended pain relief.

Special Considerations for Women Undergoing Facet Joint Block Procedures

When considering a Facet Joint Block procedure, women should be aware of a few important considerations:

• Pregnancy Status: It’s crucial for women to inform their healthcare provider and the medical team if there’s any chance they could be pregnant. Certain procedures and medications may pose risks during pregnancy, so full disclosure helps ensure safety and the most appropriate care.
• Radiation Exposure: Though not typically a concern for Facet Joint Block procedures, it’s essential to discuss any worries about radiation with your doctor. They can provide guidance on the safety measures in place to protect both patients and potential pregnancies.
• Menstrual Cycle Considerations: While not commonly impactful, some women may prefer to schedule procedures around their menstrual cycle for personal comfort. Discuss any preferences or concerns with your healthcare team.

By addressing these considerations, women can work with their healthcare professionals to ensure the safest and most effective treatment planning.

Conclusion

Facet joint blocks are valuable procedures for diagnosing and managing pain originating from the facet joints in the spine. By administering medication directly into the affected joint or surrounding nerves, facet joint blocks can provide both diagnostic and therapeutic benefits. The procedure is relatively safe and minimally invasive, offering relief from facet joint-related pain and improving the overall quality of life for individuals experiencing chronic spinal pain. If a patient is considering a facet joint block, the patient should consult with a spine care professional like the doctors at the Southwest Scoliosis and Spine Institute who can evaluate the patient’s condition and determine if this procedure is appropriate.

Why Make an Appointment with the Southwest Scoliosis and Spine Doctors

The Southwest Scoliosis and Spine Institute is a private medical practice located in three locations in Dallas, Plano, and Frisco, Texas. The practice specializes in the diagnosis and treatment of spinal conditions, including scoliosis, kyphosis, and other spinal deformities. Furthermore, the Institute offers a variety of treatment options, including surgical and non-surgical approaches.

The Southwest Scoliosis and Spine Institute maintains a team of highly experienced and skilled spine surgeons.  These doctors have received specialized training in the diagnosis and treatment of spinal conditions. Therefore, they use the latest techniques and technologies to ensure the best possible outcomes for their patients. Combined they have seen 100,000 patients and performed surgery on 16,000 of them.

The Institute’s approach to spine treatment centers on the patient, meaning that the doctors and staff approach each patient differently. Moreover, they work closely with their patients to understand their individual needs and goals and develop a customized treatment plan that takes into account the patient’s unique situation, lifestyle, and preferences.

The Institute also offers comprehensive follow-up care and support to its patients.  This includes physical therapy and rehabilitation, to help them recover quickly and fully from their surgery.

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Radiology Info: Facet Joint Block