Facet joint nerve block

What is a facet joint nerve block?

The human spine is made up of a number of bones stacked up on top of each other, these bones are called vertebrae. They are joined together and supported by ligaments and muscles. The little joints that link the vertebrae together are known as facet joints. They help to stabilise your spine and allow movement. Facet joints occur in pairs along the length of the spine. The joints that cause the most problems are those in the neck (cervical facet joints) or those in the lower back (lumbar facet joints). There may be involvement of more than one set of joints due to age related changes, injury, inflammation (tissue response to irritation) or previous disc problems.

Facet joint nerve block is an injection of local anaesthetic (with or without steroids) around the small nerve that carries the pain signals from the joint. Depending on the number of joints involved, it is usual to do more than one injection. The injection is used as a test procedure to see if the pain is arising from the joint or the nerve itself. If the injection helps lessen the pain a longer lasting procedure may be offered to you at a later date.

Benefits

Some patients will experience good pain relief from the procedure. Although the facet joint nerve block may not provide long term relief of symptoms all the time, it can help your doctor decide whether to offer you a different procedure (e.g radiofrequency denervation) which may provide pain relief for a longer period of time

Risks

No medical procedure is totally risk free. Short term side effects include pain and discomfort at the site of the injection, infection, bruising and bleeding. There is a possibility that you may have an allergic reaction to the drugs used. The local anaesthetic can spread and cause some numbness in the buttocks and legs. This is temporary and will resolve. Long term effects are uncommon and include the possibility of an increase in pain, permanent neurological problems such as numbness and weakness.

Before the procedure

• You will receive the treatment as a day case.

• You will be sent an appointment to attend the surgical day unit.

• Your stay may vary between two to four hours.

• You can eat normally and take your routine medications (unless advised differently by your doctor)

• Please bring a list of your current medications with you and inform your doctor of any allergies.

• As the procedure involves the use of x-rays, please inform medical personnel if there is any possibility of pregnancy.

• You will be asked to undress and put on a theatre gown (you can keep your underwear on).

• Your doctor will discuss the procedure with you and ask you to sign a consent form.

The procedure

• The procedure is carried out under x-ray screening. This allows the doctor to identify the specific level of the facet joint to be treated.

• Once you are in the correct position (lying on the front), doctor will clean the injection area with an antiseptic solution which may feel cold.

• Numbing medicine is injected in the skin. This may sting initially, before the skin goes numb.

• It important that you keep still during the procedure as the needle will be carefully inserted under x-ray control into the correct position. You may feel a pushing sensation or some discomfort at this stage. You can talk to the doctor all the time to inform any discomfort.

• Once the needle is in the correct position the doctor will inject the local anaesthetic/ steroid.

• A small dressing will be placed over the site of the injection. This can be removed later when you have a shower.

After the procedure

• Please be careful when you first get out of the trolley – ensure you are steady on your feet.

• You will get changed into your normal clothing and be taken to a recovery area.

• The nursing staff will observe you before going home.

• Please arrange a transport to go home, you are advised not to drive immediately after the injection.

• There can be an initial exacerbation of discomfort before you start experiencing the pain relief. Take your regular medication and pain killers as normal.

The information in this leaflet is not intended to replace your doctor's advice. If you require more information or have any questions, please speak to your doctor prior to consenting for the procedure.