Facet Joint Pain

​Topics
1. What are the Facet Joints?
2. How is Facet Joint Pain diagnosed?
3. How is Facet Joint Pain treated?
4. What is a Medial Branch Block?
5. How does a Medial Branch RFA differ from a block?
6. What are the side effects of a Medial Branch RFA?

What are the Facet Joints?

Facet joints, also known as zygapophyseal joints, are small joints located between the vertebrae of the spine. They connect the vertebrae to one another and are responsible for guiding and limiting the motion of the spine. Facet joints are found on both sides of the vertebrae, linking the superior articular process of one vertebra with the inferior articular process of the adjacent vertebra.

The structure of facet joints consists of cartilage-lined surfaces, synovial fluid (which lubricates the joint), and a joint capsule that surrounds the joint, providing stability. The orientation of facet joints varies depending on the region of the spine, which influences the type and range of motion allowed in that region.
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Facet joints play a crucial role in supporting the spine and facilitating various movements, such as bending, twisting, and flexing. However, they can also be a source of pain and discomfort, particularly if they become inflamed, degenerated, or injured due to conditions such as osteoarthritis, facet joint syndrome, or spinal stenosis.

How is Facet Joint Pain diagnosed?

Facet joint pain typically presents as localized discomfort in the spine, often described as a dull ache or sharp pain. The pain is commonly felt in the lower back (lumbar region) or neck (cervical region), depending on the location of the affected facet joints. It may also radiate to nearby areas such as the buttocks, hips, or shoulders.

Facet joint pain is diagnosed based on clinical history, examination and radiological evaluation. However, it is important to know that radiological evidence of facet joint arthritis is common even in patients who are asymptomatic. Therefore, the gold standard for diagnosing this condition is through a diagnostic medial branch block.  (see below)

How is Facet Joint Pain treated?

When you first experience low back pain, the usual approach is to start with non-invasive treatments, such as taking medications to help manage the pain and undergoing physical therapy to strengthen your back and improve flexibility.

If you've been dealing with low back pain and your doctor suspects it might be due to facet joint syndrome but the usual treatments haven't provided enough relief, they might suggest a procedure called a diagnostic medial branch block. This procedure helps confirm whether the facet joint is the source of your pain.
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If the facet joint is confirmed as the main cause of your pain, a treatment called radiofrequency ablation (RFA) might be recommended. RFA works by targeting the nerves that supply the facet joint, effectively reducing the pain signals they send to your brain.

What is a Medial Branch Block?

A medial branch block is a diagnostic procedure used to identify the source of back or neck pain suspected to originate from the facet joints in the spine. During the procedure, a small amount of numbing medication is injected near the medial branch nerves that supply sensation to the facet joints. If the injection provides temporary pain relief, it suggests that the facet joints are the source of the pain. This helps guide further treatment decisions, such as radiofrequency ablation (RFA), which targets these nerves for longer-lasting pain relief.

How does a Medial Branch RFA differ from a block?

A medial branch block is primarily a diagnostic procedure aimed at identifying the source of back or neck pain suspected to be originating from the facet joints in the spine. This block generally gives pain relief for hours to days.

On the other hand, medial branch radiofrequency ablation (RFA) is a therapeutic procedure used to provide longer-term pain relief by disrupting the function of the medial branch nerves. In RFA, a specialized needle is inserted near the medial branch nerves under X-ray guidance, and a radiofrequency current is applied to create heat. This heat effectively "burns" the nerve, disrupting its ability to transmit pain signals to the brain. As a result, patients often experience significant reduction or elimination of facet joint pain for an extended period of time.

What are the side effects of a Medial Branch RFA?

This procedure is generally considered a very safe procedure. However, like all medical procedures, there are some risks that you should be aware of.

Common side effects of this procedure include temporary increase in back pain (particularly at the injection site) that can last up to 2 weeks after the procedure. Rarely, there can be abnormal skin sensation in the back lasting for weeks, bleeding, infection and injury to the spinal nerves.