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Facet Medial Branch Block and Lumbar Spinal Arthritis: FAQs

How long does a facet medial branch block injection provide pain relief? The duration of pain relief depends on several factors including the cause of pain, degree of joint damage, and the facet joint medial nerve's reaction to the steroid.

If the nerves are blocked, how can I be sure I won't hurt myself?
The medial branch nerve only provides sensation to the facet joint. The spine's natural restraints – bones, ligaments, tendons and muscle attachments help to keep the spine for over extension or flexion. This phenomenon has not been reported in medical literature.

If the injection works, why does it have to be performed twice before proceeding to radiofrequency ablation?
Believe it or not, there is a 33% reported placebo rate with interventional procedures. Because of this, insurance companies will not allow a radiofrequency ablation (RFA) procedure to be performed without two diagnostic injections, which decrease the odds of the effects being placebo.

What do you mean burn the nerves?
The medial branch block procedure blocks the transmission of pain from the facet joint to the spine, in essence cutting the power supply to the facet joints. If the medial branch block is performed and you experience good pain relief, then you may be a candidate for a radiofrequency nerve ablation.

Radiofrequency ablation (RFA) is performed using a heat resistant-coated needle, similar to Teflon®. The needle tip is coated. The needle tip is positioned near the target nerve and radiofrequency (a radio wave) produces heat to lesion the nerve.

Does a radiofrequency ablation procedure hurt?
RFA generally is not painful. The needles are slightly larger than those used to perform a nerve block. Some patients experience soreness for a day. Rarely is it necessary to take anti-inflammatory medication for post-procedure pain.

What are the potential complications of a RFA procedure?
The potential for complications is small and similar to other interventional procedures: bleeding, infection, increased pain, or inability to obtain good long-term pain relief.

Is the effect from a radiofrequency ablation procedure permanent?
It may be, but it depends on the underlying cause of your pain. If pain is secondary to a degenerative condition, such as arthritis or spondylolisthesis, the nerves may regenerate (grow back) in 6 months to one year. It is possible you may need another radiofrequency ablation procedure at that time, depending on the severity of your pain.

Why should I undergo this procedure first if I am considering a fusion surgery?
The facet joints should be ruled out as a source of pain before proceeding with spine surgery, such as fusion. The facet joints can cause pain similar to the pain secondary to degenerative disc disease.

A medial branch block can be viewed as a diagnostic test to determine if the facet joints are involved. Facet joint involvement should be ruled out if evidence of facet joint disease presents on CT or MRI. We urge our patients to remember that although arthritis or degenerative disc disease may appear on an MRI, it does not always mean that is the cause of pain.

Treatment of Spine Pain

If you are interested in learning about the cause and treatment of your pain problem, please contact our pain management experts at The Spine and Pain Institute of New York in Manhattan, New York and Staten Island, New York. We would be happy to make an appointment for a consultation and provide additional information about other treatment options.

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