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Facet Injections, Medial Branch Blocks and Radiofrequency Ablation

If conservative treatments do not provide adequate pain relief of your back or neck pain, intraarticular facet injections or medial branch blocks with progression to radiofrequency ablation (RFA) may provide additional relief. These treatments may be helpful if you have pain from zygapophyseal joints, also known as facet joints. These are the joints between the vertebrae that provide structure and stability for the spine. These joints can themselves be a source of pain. Each joint is innervated by a small nerve branch, called the medial branch, which comes off the larger nerve root as it exits the spinal column. Pain from these joints can result in:

Pain from the facet joints is usually worse with standing, extension-rotation test, or arching your back, feels paraspinal (just to either side of midline) and is better with walking and sitting.

Conservative therapy is typically recommended as initial treatment, including:

We usually recommend trying the above conservative therapies for approximately six weeks. If you are still experiencing significant pain and/or functional limitation due to your neck or back pain, it is appropriate to move forward with the pre-injection process, which involves:

When you meet with your provider, they will discuss whether it would be best for you to undergo intraarticular (into the joint) facet injections or medial branch blocks first. It is typical to undergo two sets of diagnostic medial branch blocks (MBBs) prior to progression to radiofrequency ablation. This is necessary due to possible false positive result, as well as for most insurance companies to authorize the RFA procedure.

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What is the Difference Between Facet Injections and Medial Branch Blocks?

Facet injections are also called intraarticular, or into the joint, facet injections. They are carried out by performing a targeted injection under fluoroscopic (X-ray) guidance of both numbing medication and steroid into the joint(s) your provider believes to be painful. These can be both diagnostic and therapeutic.

Medial branch blocks (MBBs) are generally accepted as having a higher diagnostic potential than facet injections and are used to confirm your diagnosis of facet joint pain. This entails undergoing a targeted injection under fluoroscopic guidance of a numbing medication around the medial branch of each vertebral level your provider believes to be painful. We then have you keep a 6-hour pain diary which allows us to see how much relief you experienced. If we believe you had significant results, we will schedule the second set of MBBs. If you experience similar or greater benefit from the second set, we feel confident that your pain is coming from the facet joints, and you will then have your RFA scheduled.

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Radiofrequency Ablation (RFA)

Radiofrequency ablation (RFA) is a procedure used to treat many pain complaints. It is performed on a separate day in an outpatient setting, at a surgery center. You will be positioned on your stomach for the procedure and may choose to receive sedation if you are nervous, or to help you feel more comfortable during the procedure. Your doctor will use fluoroscopy (x-ray) to identify the target levels, then he will advance a special needle which heats at the tip to the medial branch nerve. Once correct placement of the needle is confirmed, your doctor will begin the ablation procedure. Heating the nerve that is causing your pain actually stops it from transmitting pain signals. Once the procedure is complete, you will be taken to the recovery area for approximately 45 minutes. You may experience some soreness after the procedure, and it can take up to two to six weeks to experience the full benefit of the RFA procedure.

It is important to note that while the RFA can provide pain relief, rehabilitation with physical therapy may still be necessary in most cases. With the relief of pain, you should be able to be more successful with your rehab efforts. You will return to our office six weeks after your RFA so we can assess your response and overall pain relief.

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Exceptional Pain Management Treatment

At the Denver Spine and Pain Institute, we have witnessed firsthand how debilitating spine pain can impact your quality of life. Our team is committed to providing you with the relief necessary to enjoy your favorite activities and perform daily activities with ease. Our goal is to help you live life to the fullest once again.

Our exclusive Connected Care Approach™ has been designed with your needs in mind, and it will get you back to enjoying life without the frustration and challenges that often come along with chronic pain. As part of this approach, you’ll receive:

  • A full spectrum of care options, including physician treatments, diagnostics, physical therapy, massage, diet and lifestyle coaching, behavioral health services and other cutting-edge treatments
  • Individualized care plans to address your unique pain needs
  • Caring and therapeutic relationships with our team to ensure you receive the best possible treatment
  • A detailed discussion of all your treatment options so that you can make an informed decision about your care

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Please contact us today to schedule an appointment. The Denver Spine and Pain Institute serves patients in Denver and the surrounding areas of Colorado.

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