What is a Facet Injection? If you've watched our other videos you know that
the Facet is a joint in the back of the spine that connects one bone to the
other. Over time the facet joints can develop arthritis and develop pain.
Sometimes the facet joint can be injured, and painful after this injury. In certain
situations an injection of medication into those Facet joints can provide
some relief. Facet joints can be injected with a combination of an
anesthetic and a type of cortisone. If the injections are beneficial, then the
medications will reduce the inflammation associated with the facet joint. The
procedure is performed by lying the patient down on a special x-ray table
that allows fluoroscopic views of real-time x-rays. Which are then used to
direct the needles into the facet joints. Once confirmed the positioning, sometimes
a small amount of dye is also injected into the facet joint to confirm adequate
placement. Then a small amount of anesthetic agent along with an
anti-inflammatory agent is administered. The procedure is typically done without
sedation. Although some patients can request a sedative.
If beneficial, medications will reduce the swelling associated with the facet
joint. The acute flare-up of pain associated with arthritis or injury will
subside. Sometimes physicians will recommend a different type of injection
to relieve the pain associated with an irritated Facet joint. These injections
are called the medial branch blocks. To review the anatomy there are small
nerves associated with the facet joints called the medial branches of the
primary ramus of the spinal nerves. I know,
big words, these are nerves that come off the spinal cord that go to the arms and
legs. Associated with the larger spinal nerves are also the small medial branch
nerves that signal pain or irritation from the facet joints. The medial branch
block is an anesthetic delivered to these nerves to cause them to stop
registering pain. Anesthetic blocks can wear off. Some
doctors will use a procedure called radio frequency ablation to effectively
cut these nerves, providing a more lasting relief. I've personally used both
techniques. For selected patients, the procedure can be beneficial. Facet
injections can provide months of relief. Medial branch blocks as well.
Radio frequency ablations can provide up to a year of relief, but it doesn't work
for all people, and may not provide relief when repeating the procedure.
There is a theoretic concern about the medial branch blocks. The analogy I'd like to
use is that of the check engine light. If your car engine has a problem, there's
usually a warning light that signals a potential problem. Pain actually is a
signal indicating this potential issue. The medial branch blocks and associated
radio frequency ablations are basically similar to just removing that check
engine light. While the engine may not register a problem, it doesn't mean that
the pain or the problem does not exist. I know, this is a controversial statement.
Many doctors believe that there is a benefit for removing this check engine
light to eliminate pain, but doctors also know the pain signals can be necessary
to prevent overuse of the painful body part. In a car, if you do not investigate
the reason for a check engine light, you might be delaying repair of the engine
or something even worse. Are we doing the same for the spine with these medial
branch blocks? So far, there's not been enough data to suggest there are
long-term, bad ramifications to these medial branch
blocks and ablations, but time will tell. If you'd like more
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