Facet Blocks

CERVICAL AND LUMBAR FACET BLOCKS

What are Cervical and Lumbar Facet Blocks?

Facet blocks consist of injection of local anesthetic and occasionally a steroid into a small joint space that connect adjacent vertebral bodies. These joints have been shown to be load bearing and have a stabilizing effect that prevents excessive rotation or forward slippage of the vertebral bodies. Stresses on the facet joints can occur by sudden or repeated lifting and twisting motions of the lower back or neck leading to irritation or injury. As you get older, arthritic changes may play a role in the development of facet syndrome. In addition, each facet joint has a small nerve associated with it. These nerves contain mostly sensory information. The nerves supply the facet joints, ligaments, skin, and small muscles at each segment. These are NOT the nerves that are responsible for movement of the extremities and sensation in the extremities. Blocking the facet joint and or nerves by either local anesthetics or RF Lesioning produces both relief of neck or back pain. Facet blocks are both therapeutic and diagnostic for facet disease.

How Is The Diagnosis of Lumbar Facet Disease Made?

Lumbar facet arthropathy usually presents as a deep dull ache. The patient can also exhibit referred pain in the buttock, groin, hip, or posterior and lateral thigh. Rotation, lateral flexion, and extension of the neck or back increases facet stress and can reproduce the pain. Flexion of the neck or back may relieve the pain. X-rays, MRIs, or CT imaging may show evidence of facet disease.

How is the Procedure Performed? Facet blocks are performed by Dr. Jagodowicz in an operating room setting as an outpatient. An IV will be started so that relaxation medication can be administered to you. All precautions will be taken to ensure a sterile environment during the procedure. A local anesthetic will be used to numb the skin over the neck or back area. Dr. Jagodowicz will then direct a special needle(s), using x-ray guidance, into the facet area. When proper placement has been confirmed by fluoroscopy (x-ray) a numbing medicine (Xylocaine) and sometimes a steroid (Depo Medrol or Kenalog) is injected at the facet space.

Is the Procedure Painful?

You may feel some pressure sensation as the facet space is entered. You will receive sedation (usually by an Anesthesiologist) during the procedure and discomfort will be kept to a minimum. Post procedure, you may experience some injection site tenderness for several days. Cool compresses for 15 minute intervals on and off will usually control the discomfort for the first day.

Are there any Risks or Side effects from the Procedure?

Any time there is an injection through the skin, there is a risk of infection. This is why sterile conditions are used for this procedure. Although rare, nerve injury may occur.

What are the Results of Facet Blocks?

Facet blocks produce pain relief in up to 94% of patients with symptoms indicative of facet-mediated pain. Due to false -negative and positive response, at least 2 block procedures should be performed. If blocks are successful, we will consider a more lasting intervention-Radiofrequency Lesioning of the facets.

Who should not have this Procedure?

If you are on blood thinning medication (e.g. Coumadin, Plavix), or if you have an active infection or fever, you should not have the procedure. The procedure can be performed after a period of time when either blood thinning medication has been stopped, or when no active infection or fever is present. If you are pregnant, you should not have this procedure.

What are my Pre/Post Procedure Instructions?

Patients should have nothing by mouth for at least 6 hrs. prior to the procedure. You may take your regular medication (blood Pressure) with a sip of water. You will need a ride home and you should not drive yourself for at least 8 hrs after the block. You can return to normal activities the following day.

RADIOFREQUENCY LESIONING FACETS

What is Radiofrequency Lesioning?

Radiofrequency lesioning is a simple and safe treatment for facet joint degeneration. It is performed as an outpatient procedure in an operating room under fluoroscopic (x-ray) guidance and mild sedation. Using a specialized machine, pain signals to the specific areas of the spine involving the nerves to the facet joints are interrupted. Clinical data shows that this method is effective in providing lasting pain relief. Patients are encouraged to resume normal activities at their pace after this procedure.

How is This Procedure Performed?

Radiofrequency Lesioning (rzidotomy) is performed by Dr. Jagodowicz in an operating room setting as an outpatient. You will be lying on your stomach. Both local anesthesia and a mild sedative may be used to minimize any discomfort during the procedure. Your cooperation is necessary during the sensory and motor stimulation process to aid in properly placing the lesioning electrode. Fluoroscopic control (x-ray) is used to help ensure safe and correct placement of the needle. Once the needle(s) are in the exact target area, a microelectrode is inserted through the needle to begin the stimulation process. During this process, Dr. Jagodowicz will ask you if you feel a tingling sensation. If there is stimulation down an extremity, the needle is moved to a different location before lesioning. After the positioning of the needle(s) are in the exact area, lesioning is then performed. A small amount of current will travel through the electrode into the surrounding tissue and eliminate pain pathways. This procedure can take from about twenty minutes to an hour.

What Are the Benefits of Radiofrequency Lesioning?

Because the procedure disrupts nerve conduction (pain signals) by heating these nerves, it may in turn reduce your pain and other related symptoms. Approximately 70-80% of patients will get good results from this procedure if the facet nerves were the cause of their pain. Sometimes after the small facet nerve(s) are destroyed, it becomes clear that there is pain from other areas as well.

Is the Procedure Painful?

You may feel some pressure or tingling sensations during the testing phases of the procedure. You will receive sedation (usually by an Anesthesiologist) during the procedure and discomfort will be kept to a minimum. Post procedure, you may experience some injection site soreness for several days. Cool compresses for 15 minute intervals on and off will usually control discomfort for the first day.

Are There any Risks or Side Effects from this Procedure?

Any time there is an injection through the skin, there is a risk of infection. This is why sterile conditions are used for this procedure. Although rare, a nerve root injury may occur.

Who Should Not Have This Procedure?

If you are on blood thinning medications (e.g. Coumadin, Plavix), or if you have an active infection or fever, you should not have this procedure performed. The procedure can be performed after a period of time when either blood thinning medications have been stopped, or when no active infection or fever is present. If you are pregnant, you should not have this procedure.

What Are My Pre/Post Procedure Instructions?

Patients should have nothing by mouth for at least 6 hours prior to the procedure. You may take your regular medication (e.g. blood pressure) with a sip of water. You will need a ride home and you should not drive yourself for at least 8 hours after the procedure. You can return to normal activities the following day.

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