Pain Caused by Arthritis & Injury of Facet Joints
The facet joints support and stabilize the spine in the neck and back. These joints can become irritated, inflamed, and painful as a result of arthritis and injury. Facet joint pain is often increased with movement and bending.
Two minimally invasive therapies known as Medial Branch Block Injections of the Facet Joints and Radiofrequency Denervation of the Facet Joints are now available to help relieve pain in the neck and back. These procedures are not intended to relieve pain in the arms or legs. Both procedures can be performed in our office while you are awake and do not require incisions.
Medial Branch Block Injections of the Facet Joints
What are Medial Branch Block Injections?
Medial Branch Block Injections are test blocks used to determine if your pain is caused from irritation of the facet joints. These injections may provide temporary pain relief for up to 12 hours if they are effective. Your response to the medial branch blocks will determine whether you are eligible for Radiofrequency Denervation of the Facet Joints which provides longer pain relief.
In addition to facet joint arthritis, other potential causes of neck and back pain include disc herniations, disc tears, vertebral fractures, nerve irritation, spinal cord compression, and muscle spasm.
Your physician may recommend medial branch block injections if he suspects that your pain is caused by irritation of the facet joints. These diagnostic injections are used as “test blocks” to determine whether you experience pain relief and improved function when the nerves that innervate the facets joints are numbed. Medial branch block injections are performed only to confirm that your pain is caused from inflammation and irritation of the facet joints and are not intended to provide long-term pain relief.
Medial branch block injections will only provide temporary pain relief for up to 12 hours if they are effective. Your response to the medial branch block injections will help your physician determine whether you are an appropriate candidate for Radiofrequency Denervation which is a similar procedure that provides longer pain relief and is described in the next section of this brochure. Your physician is required to document your response to the medial branch “test blocks” before he can perform radiofrequency denervation.
How are Medial Branch Block Injections performed?
Your skin will first be numbed to maximize your comfort during the medial branch block injections. Thin needles will then be placed near the medial branch nerves that innervate the facet joints using fluoroscopy (low dose x-ray). These small nerves do not control the movement or sensation in your arms or legs. Your physician will then place numbing medicine onto these nerves to see if you experience temporary pain relief and improved function.
Medial branch block injections are usually performed at up to four sites in a single day. The entire procedure can usually be performed within 15 minutes. You are required to bring a driving escort with you to the clinic and should not drive for the remainder of the day.
How will you determine my response to Medial Branch Block Injections?
Please remain active for the remainder of the day. Your response will be used to determine whether you are a favorable candidate for radiofrequency denervation. For this reason, it is important that you accurately record your pain and activity levels each hour for the remainder of the day. Please record this information in the pain diary we will provide to you. Be sure to bring this pain diary back to our office for your next scheduled appointment. Your physician must review this information in order to determine whether you are a favorable candidate for radiofrequency denervation.
Radiofrequency Denervation of the Facet Joints
What is Radiofrequency Denervation?
A procedure performed with needles that provides sustained relief from facet joint pain.
You will be scheduled for radiofrequency denervation of the facet joints if you experience significant pain relief and improved function following the medial branch “test block” injections. Radiofrequency denervation is very similar to the medial branch block injections.
Thin needles will be carefully placed near the same small nerves that were numbed during the medial branch block injections. Proper needle placement will be confirmed by releasing a small current from the tip of each needle to ensure that the larger nerves that control the functions of your arms and legs are not stimulated. The medial branch nerves will be numbed once needle placement is complete.
Radiofrequency current will then be transmitted onto each of the nerves to block the transmission of pain signals to your brain and spinal cord. Each nerve is treated for up to three minutes. A small amount of steroid medication is usually deposited at each radiofrequency site to help reduce post-procedure discomfort.
Radiofrequency denervation can be performed at up to four sites in a single day. The procedure can usually be performed within 45 minutes. We recommend that you apply ice to the needle sites for 10 minutes up to 6 times daily to help reduce post-procedure discomfort. You are required to bring a driving escort with you to the clinic and should not drive for the remainder of the day. You may resume normal activities and return to work the following day.
How long will the benefits of Radiofrequency Denervation last?
The benefits of Radiofrequency Denervation may last longer than 4 months. However, the results vary among patients. Most of our patients experience several months of pain relief, improved function, and reduced medication use. The radiofrequency denervation procedure may be repeated at the same sites if your pain returns as the medial branch nerves slowly regenerate. The procedure can also be performed at additional sites in your spine if necessary.
Is Radiofrequency Denervation safe?
Dr. Kornick and Dr. Kramarich recently published a large clinical study focusing on the safety of radiofrequency denervation in the lower spine. This study demonstrated only a 1% incidence of minor side effects associated with each radiofrequency denervation site. No severe complications such as bleeding, infection, or permanent nerve damage were identified. Click here for a copy of this study.
A board-certified, fellowship-trained pain medicine specialist will perform your radiofrequency denervation procedure at Riverside Spine. Fluoroscopy will be used to identify the exact location of each needle in relation to your spine during the radiofrequency denervation procedure.