Treatments
15. Facet or Medial Branch Blocks
Background: The z-joints (facet joints) are located in the back of your spine. They prevent excessive twisting of the spine in the low back, and excessive extension in the neck. In the low back, they carry 15% of the weight of your spine, but this can go as high as 65% if the disc is exceptionally narrow.
Objective: To diagnose pain in the facets (impossible via x-ray, CT scan, MRI, or bone scan). Depending on the level of your relief, you may benefit from Radiofrequency Neurotomy for longer term relief (refer to that treatment on this website for more information). Treatment may also provide up to 12 hours of relief from pain. Symptoms: Pain in the low back or neck. Indicated For: Joint damage to the neck or low back due to trauma (automobile accidents, falls), arthritis, infection, reduced disk height, or repetitive and sustained lifting of heavy objects. Damage might result in eroded cartilage lining, overgrowth of bone (bone spurs), fractures through the joint, tears in the thick fibrous capsule over the joints, or bruising/bleeding into the joints.
Treatment: For low-back pain, you lie face-down on a soft table, and for neck pain, you lie on your side. After we prepare your skin, we inject a small amount of local anesthesia into the skin. Using an x-ray and iodinated x-ray dye, we then guide a thin needle onto the medial branch nerve. We inject the medication and remove the needle. We’ll be asking you questions about mild electrical signals and other sensations. Depending on your response, we might repeat the injection up to three times.
Pre-Treatment: If no sedation is scheduled, please eat and drink normally on the day of the procedure. If sedation is scheduled, then please refrain from eating and drinking from midnight the day of the procedure—except for regular medications. Medications: 14 days prior to the treatment, stop Tclid (ticlopidine). 7 days prior, stop Plavix. 5 days prior, stop Coumadin and Warfarin.
Side Effects: Numbness of the leg or arms. Let us know immediately if you experience any new and severe generalized weakness during the first week after the treatment, experience increased pain in the back, or develop a fever of over 102 degrees. Numbness in the skin over your back for a few hours is normal. Risks: Bleeding, infection, abscess, nerve injury, spinal injury are all extremely rare.
Post-Treatment: We’ll need to keep you in the office for 20-30 minutes after the procedure to assess your pain and function, and confirm the lack of leg weakness or numbness. Resume your ordinary activity, diet, and medications, unless otherwise instructed. Feel free to remove your band-aid (if any) the day after your treatment. If there is discomfort at the injection site, apply ice wrapped in a washcloth (up to 20 minutes per hour) during the first 24 hours. After that, apply low to medium heat. IV Site: If IV was used during your procedure, there may be soreness and bruising around the site. It should go away in a few days. You can place a warm moist cloth over the area for half-hour long periods, several times a day. Important: Let us know if you experience increased tenderness or red streaking around the IV site, or swelling of your hand.