FACET INJECTION or MEDIAL BRANCH BLOCKS

 

These injections can be performed in the neck (cervical), mid back (thoracic) or low back (lumbar) regions.  These injections are usually diagnostic in nature and followed by more definitive treatments.  This include destructive procedures to interupt the neurological communication such as radiofrequency ablation or regenerative procedures (prolotherapy, Prolozone, etc.) to assist you body in healing the injured or degenerative structures.

CERVICAL FACET INJECTIONS

What is the purpose of the Cervical Facet Joint Injection?

The Cervical Facet Joint Injection is a procedure that is used to block or relieve pain caused by problems from the upper neck area. The facet joints provide stability for the neck. Cervical facet joints, which are approximately the size of your fingernail, are located on each side of the vertebrae.  These joints have small capsules of soft tissue around them that contain many pain receptors. If the joints become inflamed, you may experience pain in the neck, head, shoulders and arms.

What does the procedure involve?

The Cervical Facet Joint Injection is an outpatient procedure performed in the Special Procedure room.  For your safety, your vital signs will be monitiored.  You will lie on your stomach for the procedure. After your skin is cleansed with an antiseptic solution the doctor will inject some numbing medication that will produce a burning sensation for a few seconds.

After the numbing medicine takes effect, the doctor will insert a facet needle approximately one inch below the skin and with the guidance of a special X-ray machine called a fluoroscope, inject a contrast dye to confirm the needle is in place.  Once the needle is in the correct place, the doctor will inject a mixture of the numbing medicine (anesthetic) and anti-inflammatory medicine.  It is possible you will feel pain or pressure similar to your normal back pain as the medicine is injected.  This is a good sign and means the medicine is going to the right place. The pain usually disappears quickly.

Following the procedure, you will be asked to walk around to determine if you still have your normal pain.  We ask that you remain at the Center until the doctor feels you are ready to leave.

Can I go to sleep for the procedure?

It is not necessary for you to go to sleep for this procedure; if needed, you will receive enough medication to keep you comfortable.

How long will the procedure take?

Normally, a cervical facet joint injection takes no more than 10 or 15 minutes.

What should I do before the procedure?

You may need to stop taking certain medications several days before the procedure.  Please remind the doctor of all prescription and over-the-counter medications you take, including herbal and vitamin supplements.  Please bring a list of medications and dosages the day of your procedure.

It is very important to tell the doctor if you have asthma, if you have had an allergic reaction (i.e. hives, itchiness, difficulty breathing, and any treatment which required hospitalization) to the injected contrast dye for a previous radiology exam (CT scan, angiogram, etc.).  Also tell the doctor if you have ever had an allergic reaction to shellfish (shrimp, scallops, lobster, and crab).  The doctor may prescribe some medications for you to take before having the procedure.

Tell the doctor if you develop a cold, fever or flu like symptoms before your scheduled appointment. 

Is there anything special that I need to do after the procedure?

You may experience some weakness and/or numbness in your legs, arms or chest, depending on the location of the site that may last for a few hours after the procedure.

If so, do not engage in any activities that require lifting, balance and coordination.  Drink plenty of clear liquids after the procedure to help remove the contrast dye from the kidneys.  After your procedure we recommend that you do not take a hot shower or bath.  You make take a shower as long as the water is lukewarm. It is recommended that you do not drive for the remainder of the day. Please have an adult drive you home or accompany you.  You may resume your normal activities as tolerated.

If the doctor prescribes physical therapy, it is very important that you follow through with the physical therapy program. 

Although you may feel much better immediately after the injection (due to the anesthetic that is used), there is a possibility your pain may return within a few hours.  It usually takes between 3-7 days for the steroid medication to start working.

What are the risks of a Cervical Facet Joint Injection?

The risks, although infrequent, include: Allergic reaction to the medication; Bruising at the injection site; Infection at the injection site; Nerve damage; Puncture of dura resulting in a headache.

If you experience severe back pain, new numbness, or weakness of your legs, a headache that will not go away or signs of infection in the area of the injection, please call the doctor as soon as possible.

 

 LUMBAR FACET INJECTIONS

What is the purpose of the Lumbar Facet Joint Injection?

The Lumbar Facet Joint Injection is a procedure that is used to block or relieve pain caused by problems from the lower back. The facet joints provide stability for the lower back.   Lumbar facet joints, which are approximately the size of your fingernail, are located on each side of the vertebrae.  These joints have small capsules of soft tissue around them that contain many pain receptors. If the joints become inflamed, you may experience pain in the lower back, abdomen, buttocks, groin and legs.

What does the procedure involve?

The Lumbar Facet Joint Injection is an outpatient procedure performed in the Special Procedure room.  For your safety, the nurse will connect you to monitoring equipment (EKG monitor, blood pressure cuff, and a blood-oxygen monitoring device).  You will lie on your stomach and most likely have a pillow underneath your abdomen so that you are in the correct position.  After your skin is cleansed with an antiseptic solution the doctor will inject some numbing medication that will produce a burning sensation for a few seconds.

After the numbing medicine takes effect, the doctor will insert a facet needle approximately one inch below the skin and with the guidance of a special X-ray machine called a fluoroscope, inject a contrast dye to confirm the needle is in place.  Once the needle is in the correct place, the doctor will inject a mixture of the numbing medicine (anesthetic) and anti-inflammatory medicine.  It is possible you will feel pain or pressure similar to your normal back pain as the medicine is injected.  This is a good sign and means the medicine is going to the right place. The pain usually disappears quickly.

Following the procedure, you will be asked to walk around to determine if you still have your normal pain.  We ask that you remain at the Center until the doctor feels you are ready to leave.

Can I go to sleep for the procedure?

It is not necessary for you to go to sleep for this procedure; if needed, you will receive enough medication to keep you comfortable.

How long will the procedure take?

Normally, a lumbar facet joint injection takes no more than 10 or 15 minutes.

What should I do before the procedure?

If you receive sedation, it is recommended that you do not eat eight hours before the procedure.  If you are a diabetic, be sure to discuss your eating and medication schedule with your doctor.

You may need to stop taking certain medications several days before the procedure.  Please remind the doctor of all prescription and over-the-counter medications you take, including herbal and vitamin supplements.  Please bring a list of medications and dosages the day of your procedure.

It is very important to tell the doctor if you have asthma, if you have had an allergic reaction (i.e. hives, itchiness, difficulty breathing, and any treatment which required hospitalization) to the injected contrast dye for a previous radiology exam (CT scan, angiogram, etc.).  Also tell the doctor if you have ever had an allergic reaction to shellfish (shrimp, scallops, lobster, and crab).  The doctor may prescribe some medications for you to take before having the procedure.

Tell the doctor if you develop a cold, fever or flu like symptoms before your scheduled appointment. 

Is there anything special that I need to do after the procedure?

You may experience some weakness and/or numbness in your legs, arms or chest, depending on the location of the site that may last for a few hours after the procedure.

If so, do not engage in any activities that require lifting, balance and coordination.  Drink plenty of clear liquids after the procedure to help remove the contrast dye from the kidneys.  After your procedure we recommend that you do not take a hot shower or bath.  You make take a shower as long as the water is lukewarm. It is recommended that you do not drive for the remainder of the day. Please have an adult drive you home or accompany you.  You may resume normal activities as tolerated.

If the doctor prescribes physical therapy, it is very important that you follow through with the physical therapy program. 

Although you may feel much better immediately after the injection (due to the anesthetic that is used), there is a possibility your pain may return within a few hours.  It usually takes between 3-7 days for the steroid medication to start working.

What are the risks of a Lumbar Facet Joint Injection?

The risks, although infrequent, include: Allergic reaction to the medication; Bruising at the injection site; Infection at the injection site; Nerve damage; Puncture of dura resulting in a headache.

If you experience severe back pain, new numbness, or weakness of your legs, a headache that will not go away or signs of infection in the area of the injection, please call the doctor as soon as possible.

 

RADIOFREQUENCY LESIONING or ABLATION

What does the procedure involve?

Radiofrequency lesioning is a procedure that uses heat (radio waves) through a needle to interrupt pain signals and damage small sensory nerve endings.
The procedure is usually recommended for those patients who have failed other pain treatments i.e. nerve blocks and pain medication. Some patients report pain relief for up to two years. Nerve endings have the tendency to grow back the pain so the pain can return at some time in the future.  The procedure can be repeated if necessary.

Radiofrequency lesioning is usually done in outpatient basis in a Special Procedure Room. You will be connected to monitoring equipment (EKG monitor, blood pressure cuff, and a blood-oxygen monitoring device) for your safety and comfort.

Depending on the nerves being treated, you will be positioned on your back (for nerves in the neck) or on your stomach (for nerves in the back).  The area will be cleansed with an antiseptic solution and the physician will inject some numbing medicine into the skin that may cause a burning sensation for a few seconds. After the numbing medicine takes effect, the doctor will insert a special radio frequency needle with the assistance of a special x-ray machine called a fluoroscope. You will feel some dull pressure but not pain. After confirming that the needle tip is in position, a special needle tip (electrode) is inserted. The proper location is confirmed by fluoroscopy. The doctor will verify the correct nerve using electrical stimulation. You will feel a tingling sensation similar to hitting your “funny bone”.  You may also experience some muscle twitching.  To numb the nerves, the tissues surrounding the needle tip are then heated when electric current is passed using the radio frequency machine for 90 to 120 seconds.

After the procedure, we ask that you remain at the Center until the doctor feels you are ready leave.

Can I go to sleep for the procedure?

It is important for you to talk with the doctor and describe how you are feeling during the procedure; therefore, you will not be put to sleep. If needed,  you will receive medication to keep you comfortable.

How long will the procedure take?

Depending on the situation, radio frequency lesioning will take from 30 minutes to over one hour.

What should I do before the procedure?

It is recommended that you do not eat within four or five hours before the procedure, since you will be receiving medication.  If you are a diabetic, be sure to discuss your eating and medication schedule with your doctor.

Certain medications may need to be stopped several days before the procedure.  Please remind the doctor of all prescription and over-the-counter medications you take, including herbal and vitamin supplements.  Please bring a written list of your current medications and dosages on the day of your procedure. 

If you develop a cold, fever or flu symptoms before your scheduled appointment, please notify the doctor.

Is there anything special that I need to do after the procedure?

After the procedure, some muscle soreness may occur for a few days.  If so, you may apply ice or a cold compress to the affected area. 

Please have an adult drive you home or accompany you the day of the procedure.  Do not drive for the remainder of the day. You may resume your normal activities as tolerated.

If the doctor prescribes physical therapy, it is important that you follow through with the physical therapy program.

What are the risks of Radio Frequency Lesioning?

The risks, although infrequent, include:  Allergic reaction to the medication; Infection at the injection site; Bruising at the injection site; Damage to nerves or blood vessels near the lesioned nerve.

 

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The YANN TRUST

IN LOVING MEMORY OF YASMIN ALGARIN

Yasmin was, and always will be, a shining example of a how a person can achieve anything with hard work and a life-affirming attitude. She gave more than she took, she loved more than she feared, and she nurtured her family and friends at every opportunity. We will always remember Yasmin as a woman of strength, courage and compassion. 

Due to her untimely passing from brain cancer, we have set up a trust fund for her two children, Niles and Nylah. Please make your checks payable to: The YANN Trust (Yasmin Algarin Niles Nylah), 197 Ridgedale Ave., Suite 210, Cedar Knolls, NJ 07927.

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DISCLAIMER

The pages on this website contain general guidelines and information based on acceptable standards and should not be construed as medical advice. 

Please consult your own physician for appropriate management about your medical condition.