The Pain Specialist
3 Mount Elizabeth #15-09
Medical Centre Singapore 228510
Facet joints connect the vertebrae, the bones of the spine, in neck, upper back and lower back. They help guide your spine when you move. Facet joints are found on both sides of the spine. Each is about the size of a thumbnail. Facet joints are named for the vertebrae they connect and the side of the spine where they are found. The right L4-5 facet joint, for example, joins the 4th and 5th lumbar vertebrae on the right side.
Medial branch nerves are found near facet joints. They communicate pain from the facet joint. They tell the brain when facet joints have been injured. Each facet joint has two or three medial branch nerves that communicate pain.
You may feel pain if a facet joint is injured. Sometimes it feels like simple muscle tension. Other times it can be severe pain. The cartilage inside the joint may be injured. Other times only connecting ligaments surrounding the joint are injured.
Facet pain also depends on which joint is affected. The diagrams show areas of pain usually associated with facet injuries.
If you have pain in one or more of these areas (shown in the diagram), and it has lasted longer than two months, you may have facet pain.
Common tests such as x-rays or MRIs may not show if a facet joint is causing the pain. The best way to diagnose facet pain is to do a medial branch nerve block.
A medial branch nerve block is a procedure in which an anaesthetic is injected near small medial nerves connected to a specific facet joint. Typically, several levels of the spine are injected in one procedure.
If the patient experiences marked pain relief immediately after the injection, then the facet joint is determined to be the source of the patient’s pain.
This procedure is primarily diagnostic, meaning that if the patient has the appropriate duration of pain relief after the medial branch nerve block, then he or she may be a candidate for a subsequent procedure, called a medial branch radiofrequency ablation, for longer term pain relief.
RFA uses radiofrequency energy to disrupt nerve function. When it is done to a medial branch nerve, the nerve can no longer transmit pain from an injured facet joint.
In cases where a medial branch nerve block has confirmed that a patient’s pain originates from a facet joint, RFA (radiofrequency ablation/neurotomy) can be considered for longer term pain relief.
RFA (radiofrequency ablation) is a type of injection procedure in which a heat lesion is created on the nerve that transmits the pain signal to the brain. The goal of a radiofrequency ablation is to interrupt the pain signal to the brain, while preserving other functions, such as normal sensation and muscle strength.
How is RFA done?
When the target nerve is confirmed, a heat lesion is created on the nerve using the preferred method (conventional, pulsed, or water-cooled radiofrequency) of ablation.
This process may be repeated for additional nerves.
The entire procedure usually takes 30 to 90 minutes. It is advised to have someone drive the patient home after the procedure.
You will be monitored after the RFA. When you are ready to leave, the clinic will give you discharge instructions. You may also be given a pain diary. It is important to fill it out because it helps your doctor know how the RFA is working. Take it easy for the rest of the day.
You may feel sore for one to four days; it is normal. It may be due to muscle and nerve irritation. Your back may feel numb, weak, or itchy for a couple of weeks. Full pain relief normally comes in two to three weeks.
Nerves regenerate after RFA, but how long this takes varies. Your pain may or may not return when the nerves regenerate. If it does, another RFA can be done.
RFA (radiofrequency ablation) is minimally invasive and is usually considered a safe and low-risk procedure. However, as with any injection procedure, there is always a chance of developing side effects or other complications, depending on patients.
Immediately after radiofrequency ablation, the following side effects may be experienced:
Sometimes, these symptoms may feel like a sunburn in the treated area. While these symptoms may last for the first few days or weeks, they can be managed by resting, intermittently using an icepack over the sore area, and/or using topical or oral medication.