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Facet Joint Injections

The zygapophysial joints, also called the facet joints, are common sources of pain, either from degenerative arthritic conditions or from acute injury. The pain typically occurs with twisting or backward movements of the spine. In the neck, zygapophysial joint pathology may be associated with headaches, shoulder pain or upper back pain and, in the lower back, these joints may cause back, buttock or thigh pain. These joints are located in the posterior area of the spine and are accessed for injection with the use of X-ray imaging. Two injection techniques are used to treat zygapophysial joint-related pain and each is described below.

In an intraarticular zygapophysial injection, the joint itself is penetrated with a needle and a small amount of contrast is injected, confirming correct needle placement. Then, a combination of local anesthetic and steroid is injected. The effect of the local anesthetic may confirm the joint as a source of pain and the steroid may act to decrease inflammation for long-term relief. In some cases the injected steroid may have excellent long-term results.

In a medial branch injection, the two small nerves that supply each zygapophysial joint are blocked with a very small amount of local anesthetic, effectively decreasing the ability of the joint to generate sensation of pain. This injection is diagnostic. Therapeutic intraarticular injections may follow or the patient may undergo radiofrequency neuroablation. In this latter technique, a special needle is used to supply electrical energy to the nerves supplying the previously “blocked” zygapophysial joints, resulting in long-lasting pain relief. Radiofrequency neuroablation demands very precise needle placement and a rigorous protocol to maximize efficacy and assure that motor or sensory nerves are not damaged. Please refer to the section below.

As referred to above in the section regarding zygapophysial joint injections, thermal energy can be used to selectively destroy specific sensory nerves that are involved in the transmission of pain. Most commonly, the small nerves to the zygapophysial joints are subjected to this procedure. This technique may also be used to treat the thoracic splanchnic nerves for abdominal pain. Because the procedure physically damages the targeted nerves, the physician must take great care in properly placing the needles. Prior to the radiofrequency procedure, it is important that a separate injection procedure be performed with local anesthetic, thereby establishing the diagnosis that will predict the effectiveness of the neuroablation. When performed properly and selectively, this can be a very safe and effective pain relief technique.

Radiofrequency Neuroablation

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