Facet Joint Injections or Medial Bundle Branch Block

What are facet joints?

The facet joints, also called zygapophysial joints, are found in pairs on the back of the spinal column between adjacent vertebrae. These joints connect the vertebrae, providing stability and enabling the spinal column to move and bend.
The joints have cartilage surfaces, which act as shock absorbers, and synovial fluid lubricates them, facilitating smooth movement. When these joints are inflamed or irritated, they can cause pain due to the presence of nerve endings.

What are Medial Bundle Branch Nerves?

The medial branch nerves are small nerves that are connected to the facet joint and carry pain signals from these joints to the brain.

What are Facet Joint Injections and Medial Bundle Branch Blocks?

Facet joint injections involve the injection of local anaesthetic and steroids directly into the facet joint space to numb the pain and decrease inflammation.
Similarly, a medial branch block targets the medial branch nerves connected to the facet joints to interrupt pain signals sent to the brain.

The aim of both procedures is to evaluate whether the facet joints are the source of pain. If the injections relieve pain, it indicates that the facet joints are causing discomfort. The results of these procedures can then be used to determine appropriate treatment options.
If a medial branch block effectively reduces pain, Facet Joint Rhizolysis may be a suitable long-term treatment option.
Successful facet joint injections or medial branch blocks can decrease pain, making it easier to undergo physiotherapy or rehabilitation.

What happens before Facet Joint Injections and Medial Bundle Branch Block?

Before a nerve root block procedure, the patient will typically undergo a thorough evaluation by a specialist to determine the underlying cause of their pain and whether a Facet Joint Injections or Medial Bundle Branch Block is an appropriate treatment option.

This evaluation may include a physical exam, medical history review, and diagnostic tests such as imaging studies (e.g., X-rays, MRI, and CT scans).

If the specialist determines that a Facet Joint Injection or Medial Bundle Branch Block is appropriate, the patient will typically receive instructions on preparing for the procedure. This may include:

  • Discontinuing the use of blood-thinning medications, such as warfarin, for a specified period before the procedure
  • Do not stop any medication before talking to us.
  • Arranging for someone to drive them home after the procedure.
  • Inform us of any allergies, medications, or medical conditions you have. If there is an active infection, the procedure is not carried out.

What happens during the procedure?

The Facet Joint Injections or Medial Bundle Branch Block is an outpatient procedure that is conducted in the hospital under local anaesthesia and sometimes under sedation.

The procedure is performed in a room equipped with a fluoroscopy(X-ray). Although the injections only take a short time, the entire procedure may last up to 30 minutes.

During the procedure, the patient will be asked to lie on their front, and the doctor will take measures to ensure their comfort. The doctor will clean the skin of the neck or back area with antiseptic and cover it with sterile drapes. Local anaesthesia will then be injected into the skin to numb the area.

Next, the doctor will use X-ray images to guide the needle to the correct position. Finally, a mixture of local anaesthesia and steroid will be slowly injected into the joint or into the nerves of the facet joints in the medial bundle branch block.

After the procedure, which usually takes around 30 minutes, the patient will be monitored briefly and then typically allowed to go home within half an hour.

During the procedure, your vitals are continuously monitored.

What can I expect after the injection?

The injection of local anaesthesia may result in immediate symptom relief.
On the other hand, the steroid medication usually takes two to three days to start taking effect and may peak at one to two weeks. It's important to continue regular pain relief medication as needed.
The success of the injection in reducing pain and its duration may vary from person to person.

What are the potential side effects of the procedure?

The most frequently observed side effect of the injections is mild tenderness and/or bruising at the injection site, which typically resolves within a few days. Individuals may sometimes experience increased pain for a few days following the injection, but this should subside.
Although uncommon, more severe side effects, such as bleeding, infection, nerve damage, or an allergic reaction to the medications used during the procedure, may occur.
Although rare, seeking medical attention promptly is important if you feel unwell.

Please follow the BASS (British Association of Spinal Surgeons) website for more information.

Learn more about condition:

Facet Joint Arthritis: Learn about the onset, symptoms, and progression of Facet Joint Arthritis.