These injuries are most often caused by trauma. For example, among whiplash patients, the cervical facet joints have been implicated as a major source of chronic neck pain, often involving the upper cervical facet joints, most often the C2-3 level. Pain from an injured facet joint is often “referred” to an adjacent area, for example the back of the head or upper back area, depending on which facet joint has been injured.
The lumbar facet joints can cause similar pain patterns, with pain extending into the buttocks or thighs, again depending on the spinal level of facet joint injury.
Although MRI scanning shows facet joints, pain from or injury to these joints are not revealed by MRI. The gold standard for accurate diagnosis requires image-guided diagnostic spinal anesthetic injections. Physicians commonly call these injections “blocks” because they can temporarily block a patient’s pain and help with pinpointing the source of pain.
A facet joint block is an injection of an anesthetic and often a small amount of cortisone into the facet joint. It helps confirm if the facet joints are the source of low back pain or neck pain. Therapeutically, it can relieve pain and inflammation. In a similar procedure, the doctor injects local anesthetic into adjacent nerves that supply facet joints. This is a so-called “medial branch block” and provides additional diagnostic information.
The skin and underlying tissue is numbed with an injection of local anesthetic (Lidocaine).
Using moving x-ray image guidance (fluoroscopy), a larger needle is placed into the facet joint. A small amount of contrast dye is injected to assure correct placement. Then a small volume of corticosteroid (cortisone) plus local anesthetic is injected into the joint.
In a medial branch block, local anesthetic is injected near the facet joint at the nerves that supply the joint.
Local anesthetic injected at the facet joint will usually last 3-12 hours. The cortisone may take a few days to begin working.
Avoid heavy lifting and other activities that can stress your lower back for one or two days after the procedure.
Carefully monitor your symptoms. We generally provide you with a symptom diary to take home. Tell your provider at your follow-up appointment.
For selected patients, a facet joint block relieves pain and inflammation for weeks to months, and sometimes longer. The procedure may also help you get on with your other treatment such as an exercise program.
If the procedure provides a positive diagnostic response without long-term relief, we can discuss a longer-lasting procedure called facet joint neurotomy. This procedure requires referral to another specialist, and is illustrated in our patient library.
