Leon E. Popovitz, MD
Top-Rated Orthopedic Surgeon
Specializing in Arthroscopic Surgery of the Shoulder & Knee.
For appointments 212.759.4553

Facet Joint Injections/ Medial Branch Blocks

Facet Injections and Medial Branch blocks both target the two facet joints on either side of each vertebra. Arthritis, degenerative disc disease, or trauma may all cause deterioration of these joints, making movements difficult and painful. Damaged joints become inflamed, effected the nerve roots surrounding them. This can cause radiating pain and discomfort to the extremities as well as difficult in performing everyday tasks. A facet joint injection is administered directly into the afflicted joint. A medial branch block is administered in the associated nerve root.

Facet joint injections or medial branch blocks may be administered to any of the three regions of the spine where the damaged joints may be located; the lumbar, thoracic, or cervical spine.

Cervical Facet Injection/ Medial Branch Block

The cervical region of the spine is the neck area, consisting of seven vertebrae and the joints that connect them, allowing for movement of the neck. These joints are called facet joints. They may cause chronic neck pain and headaches when their cartilage is damaged or the ligaments connected to them are torn. The purpose of Cervical Facet Injections and Cervical Medial Branch Blocks are to diagnose this as the source of a patients’ pain and relieve it for a short time. The only difference between the two is where the needle is inserted:

  • Cervical Facet Injection- The needle is inserted directly into the joint.
  • Cervical Medial Branch Block- The needle is inserted near the medial branch nerve, stopping pain signals to the joint.

Thoracic Facet Injection/ Medial Branch Block

The middle area of the spine is referred to as the thoracic region, containing twelve vertebrae that allow the back to move. The vertebrae are stacked on top of each other, connected to each other by facet joints. These joints are surrounded by ligaments that support movement and medial branch nerves, which transmit pain signals to the brain. A Thoracic Facet Injection and Thoracic Medial Branch Block will diagnose and possibly treat pain in the upper and mid back caused by these facet joints. Thoracic Facet Injection and Thoracic Medial Branch Block differ only in the target of the injected needle.

  • Thoracic Facet Injection- The needle is inserted directly into the joint.
  • Thoracic Medial Branch Block- The needle is inserted near the medial branch nerve, stopping pain signals to the joint.

Lumbar Facet Injection/ Medial Branch Block

Lumbar Facet Injections and Lumbar Medial Branch Blocks are outpatient procedures that diagnose and provide short term treatment for lower back, hip, buttock, and groin pain. The lumbar region of the spine, or lower back, consists of five vertebrae. Facet joints connect the vertebrae on either side. If the cartilage of these joints or ligaments surrounding them undergo damage, they will cause pain that radiates down the upper back to the groin, buttock and hip. Both a Lumbar Facet Injection and Lumbar Medial Branch Block diagnose and treat these symptoms with the only difference between them being where the needle is targeted.

  • Lumbar Facet Injection- The needle is inserted directly into the joint.
  • Lumbar Medial Branch Block- The needle is inserted near the medial branch nerve, stopping pain signals to the joint.

Symptoms of Facet Joint Pain

When cartilage inside a facet joint or the ligaments of the cervix surrounding them are damaged, it can cause headaches and upper neck pain. Pain may vary from muscle tension from neck to shoulder to sharp pain in the back of the head. Damage to facet joints in other areas of the spine can make simple movements like twisting, bending, or walking painful. When nerves are compromised, weakness or tingling may occur in muscles of the back or extremities.

Causes of Facet Joint Pain

The location of the pain may also depend on which facet joint is the cause of the problem. Causes include:

  • Trauma and injury
  • Regular aging
  • Degenerative disc disease
  • Facet disease
  • Spinal stenosis
  • Bone spurs or tumor
  • Facet joint osteoarthritis

Diagnosing Facet Joint Pain

MRIs and x rays do not always reveal causal factors of pain in a facet joint. Because of this, Cervical Facet Injections and Cervical Medial Branch Blocks serve to diagnose the source of pain. If the patient is not in pain for a while after the injection, it can be determined that the facet joint is the problem. It can then be discussed between the patient and physician whether the short term injections are effective enough, or if Cervical Radiofrequency Ablation is a better option.

Preparing for the Procedure

  • Arrange to have someone else drive after the procedure.
  • Rest for the day.
  • Notify the physician about any medications you are taking.

The Procedure

A thin needle is inserted directly into the facet joint for a Cervical Facet Injection or near the medial branch nerve for a Cervical Medial Branch Block.  A local anesthetic is administered to numb the area while corticosteroids are injected for longer term anti-inflammatory relief. The doctor may inject a dye into the joint and use fluoroscopy, a type of x ray imaging, to ensure the needle is inserted in the correctly.

The patient is monitored for 30 minutes following the Cervical Facet Injection or Cervical Medial Branch Block. The patient will feel well enough to go to work the following day.

Results

The local anesthetic will numb all pain for a short time, but it will return within a couple of days. The injection site will be sore and the corticosteroid will not activate for a few days. If the pain is relieved after a week, it will probably return in another few weeks. This means that the facet joints are indeed the source of pain and the patient could be ready for Cervical Radiofrequency Ablation, which will provide more long term relief.

Risks

Any deep tissue injection runs the risk of infection or bleeding, though it is very rare. The injection site will be sore for only 2-3 days. The corticosteroid may increase blood sugar in some patients.

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