Joint Injections

1. What are facet joints?

Facet joints are located in the posterior aspect of the spinal column. These joints help with mobility and movement of the spine. Sometimes, these joints can become inflamed or develop arthritis, leading to pain.

2. What are medial branch nerves?

Medial branch nerves carry pain information from the facet joint and the surrounding muscles to the spinal cord.

What injections can be performed for pain that is coming from facet joints?

Injections into the facet joints with local anesthetic (“numbing” medication) and steroid (anti-inflammatory) can reduce inflammation in the joints. More commonly, medial branch nerve blocks and radiofrequency ablation can be performed.

3. Facet joint injections

You will be positioned on your abdomen. Your heart rate, blood pressure, and oxygen level will be monitored during the procedure. The injection site will be washed with a sterile cleaning solution. X-ray images will be taken of your spine to determine the correct placement of the needle for the injection.

Local anesthetic (“numbing” medication) will be injected into the skin. Contrast dye will be used to confirm that the needle tip is in the facet joint. Then, local anesthetic and steroid will be injected.

4. The Procedure

Medial branch nerve block (diagnostic or “test” procedure) and radiofrequency ablation (“burning” procedure)

You will be positioned on your abdomen. Your heart rate, blood pressure, and oxygen level will be monitored during the procedure. The injection site will be washed with a sterile cleaning solution. X-ray images will be taken of your spine to determine the correct placement of the needle for the injection. Local anesthetic (“numbing” medication) will be injected into the skin.

For a diagnostic nerve block, local anesthetic will also be placed near the medial branch nerve.

For a radiofrequency ablation (“burning” of the nerve to disrupt the pain signaling), the needle tip placement will be confirmed with testing, which typically feels like “tapping” or vibration. Then, local anesthetic will be injected to numb the area before performing radiofrequency ablation at each site.

5. Before the procedure

It is important that you follow all pre-procedure instructions given to you at your clinic visit; if not, your procedure may be canceled.

6. After the procedure

You will remain in the recovery room for observation; we will monitor your vital signs during this time. The staff will give you discharge instructions.

If this was a diagnostic nerve block, the local anesthetic will wear off in several hours. Your pain will return – however, what is important is whether your pain, function, and/or movement improved while the local anesthetic was present. If you have significant pain relief and/or improved function during the brief time after the injection, then you may be offered a radiofrequency ablation procedure.

The average pain relief after radiofrequency ablation is 6-18 months (until the nerves regrow). If this procedure provides significant pain relief for several months, it can be repeated, if needed.