Cervical Facet Joints
Facet joints are a set of small joints between every two adjacent vertebrae in the spine. Their function is to guide and limit the movement of each spinal segment. Cervical facet joints are those responsible for the cervical spine’s (at the neck and top of spine) ability to rotate, as well as bending forwards and backwards. They can often be disrupted by degeneration, dislocation, fracture injury, instability from trauma, osteoarthritis and surgery. Twisting injuries are also a frequent cause of damage to the facet joints. Pain caused by disruption to the cervical facet joints will be felt in the head, neck, shoulder or arm.
Facet Joint Blocks
Facet joint blocks are a common way to diagnose the specific source of pain generated in the facet joints of the spine. Numbing medicine is placed into the facet joint and the immediate pain relief experienced by the patient will help determine if the facet joint is a source of the pain.
They can also be used as a minimally invasive pain management technique, offering an additional therapeutic effect by numbing the source of the pain and soothing inflammation. This can also sometimes provide longer-term relief.
Local anaesthetic is used to numb a small area of skin on the back and a fine needle is accurately located, under X-ray guidance, near the facet joint, which administers a solution of local anaesthetic (bupivicaine) and anti-inflammatory steroid (depo-medrone) around the facet joint. Sedation may be used, particularly if patients are nervous. The procedure takes around 15-20 minutes and is done as a day-case.
With an effective facet joint block, a patient can receive several months of pain relief. This pain-free window is the ideal time to rehabilitate the area of pain, in conjunction with physiotherapy. Rehabilitation is based on exercises and movements designed to help build a strong, healthy pain-free spine. If the facet joint block is successful, but required again, radiofrequency treatment may be considered instead, which is associated with a longer duration of pain relief.
There may be some local discomfort from the administration of local anaesthetic and there is often a small bruise at the site of the procedure. Occasionally, patients get temporary numbness in the leg due to the local anaesthetic, which wears off after a few hours. Infection is a possibility but rare as full sterile precautions are taken.
Facet joint blocks can be very successful for many patients. For those who get the benefits of pain relief, sometimes only one block is required. For others the relief lasts several months. Patients will sometimes have the procedure performed 3-4 times per year to maintain their pain-free window.