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Specialist Orthopaedic Doctors

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Back Pain Injections

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Fluoroscopically Guided Digital X-Ray Injections

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Spinal Manipulation

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Exercise & Rehabilitation Programmes for the Young...

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...and the Not So Young

Lumbar Facet Blocks


Diagnostic medial branch block

The procedure known as a medial branch block is a diagnostic injection given to numb one or two joints to see if the pain reduces significantly for a few hours. If this is the case, then a lumbar facet joint injection may be given on the next visit into the joint or joints identified as producing pain. This diagnostic injection is the best single way of identifying a painful joint. X-rays, MRI scans and clinical examination also help to exclude other problems.

Lumbar facet joint injection
The procedure known as lumbar facet joint injection is given for pain arising from the small joints in the back. The pain is usually caused by osteoarthritis and is often known as lumbago. It is different from the sharp pain of sciatica, which travels down the leg.

Facet Joint Injections
Most backache related to facet joints can be treated successfully with a combination of exercise and improved posture. If your symptoms are very severe or difficult to treat, you may need an injection. In this case, your doctor will inject a mixture of local anaesthetic into your inflamed facet joint. The treatment may be given in the doctor's fluoroscopy theatre and it may be slightly painful.

Results
These injections can be very successful but occasionally provide relief for only a few months. If you are suffering from severe osteoarthritis you may find that some of the newer techniques are beneficial. These include facet joint denervation by which the nerves supplying the joints are frozen or deadened with a radio frequency probe in order to reduce pain. This is not a major operation and referral can be made for this by your GP. Facet joint injections take less than 15 seconds per joint and the results can be dramatic and can help in the diagnosis. If the injections provide only partial or temporary relief, it may be necessary to use Prolotherapy - a dextrose/glucose injection which strengthens the supporting ligaments of the lumbar spine.

Treatments and Side Effects
The doctor will have discussed alternative treatments with you first. He may have talked about Manipulation, Acupuncture, TENS or alternative medications/injections but these may not be suitable for everybody. You will be asked if you agree to the treatment. If you do, you will be asked to lie on your stomach under an X-ray machine. Identified joints may then be injected. The X-rays used are a much smaller dose than you would receive if you had a normal back X-ray.

Local anaesthetic is used, so it is not an excessively painful procedure and patients rarely need sedation. Being awake is important as we need to know which joint is tender when the needle comes into contact with it. For short-term relief and diagnostic purposes, only anaesthetic need be injected. Adding a long-acting cortisone, however, can sometimes result in several months of pain relief. This is not the same as taking steroids for long periods, as in rheumatoid arthritis.

Risks
You might not feel any benefit for the first day or two and some people feel worse temporarily for a few days. This may be due to bruising or soreness near to the injection site. It is recommended that you do not drive yourself home, although you may feel perfectly able to do so. Some people do experience a few days of 'facial flushing'. However, most people have no significant side-effects from these single dose cortisone injections.

After Care and Benefits
The diagnosis is confirmed and the pain relief should allow you to gradually increase your activities. It is important that you do not immediately take up unaccustomed exercise until your muscles have had time to acclimatise to it. Ideally, you should resume exercising in a mild fashion, taking two walks a day but limiting the distance and time to the level that you know you can easily manage. You should be able to reduce your drug intake, sleep should be improved and there should be improvement in your posture.