Facet Joint Blocks

These are also called selective nerve root blocks or sleeve injections

What are facet joints?

Facet joints are the joints between vertebra, which are present on both sides of the spine, are two in number for each disc, and provide flexibility to the spine which allows you to bend at the waist.

Each vertebra has two sets of facet joints. Once pair faces upward (superior articular facet) and one downward (inferior articular facet).  There is one joint on each side (right and left), facet joints are hinge-like and link vertebra together.  They are located in the back of the spine which is called posterior aspect.

Facet joints or synovial joints. This means each joint is surrounded by a capsule of connective tissue and produces a fluid to nourish and lubricate the joint. The joint surfaces are coated with cartilage allowing joints to move or glide smoothly against each other.

What is a facet joint injection?

Each facet joint is supplied by two nerves. A facet joint block can be performed by injecting into the joint or injecting close to the nerves supplying the joint. Injection into the joint is called intra-articular injection whereas blocking the nerves is called medial branch blocks or facet joint nerve blocks.

Most commonly at Pain Management Center facet joint nerve blocks are performed. These are much easier and more effective and require very small doses of steroids.

These blocks can be performed for the diagnosis of the pain coming from the facet joints or for the treatment of the pain coming from the facet joints.

What happens during the procedure?

The patient is taken into the holding area where an intravenous infusion is started so that small dose of sedation can be given. Following this patient is taken into the operating room and positioned on the stomach in such a way that physician can best visualize the nerves supplying the joints in the neck, mid back and low back using x-ray guidance. The skin on the back is cleaned with alcohol. Following this the physician numbs a small area of skin with numbing medicine.
Following this a small needle is passed close to the nerve under x-ray guidance. At this time a small mixture of numbing medicine (local anesthetic) and anti-inflammatory steroid is injected. One or several joints may be blocked or they may be performed in one region or multiple regions or on one side or both sides.
Cervical Facet Joint Blocks

Lumbar Facet Joint Block

What happens during the procedure?

An IV will be started so that relaxation medication can be given.

The patient is placed on the x-ray table and positioned in such a way that the physician can best visualize the bony openings in the spine where the nerve roots exit the spine using x-ray guidance in the treatment room.

The skin on the spine is cleaned with alcohol.

Next, the physician numbs a small area of skin with numbing medicine. 

After the numbing medicine has been given time to be effective, the physician directs a very small needle, using x-ray guidance near the specific nerve being tested.  A small amount of contrast (dye) is injected to insure proper needle position.  Then a small mixture of numbing medicine (anesthetic) and anti-inflammatory (steroid) is injected.

What happens after the procedure?

Immediately after the procedure, the patient will move around and try to imitate something that would normally bring about their usual pain.  In the beginning of treatment phase, patient is monitored for relief and side effects.

The arm(s), chest wall or leg(s) may feel weak or numb for a few hours following the procedure.  This is fairly common and happens following a selective nerve root block or transforaminal epidural injection.


The patient can eat a light meal within a few hours before the procedure. If a patient is an insulin dependent diabetic, they must not change their normal eating pattern prior to the procedure.

Patients may take their routine medications. (i.e. high blood pressure and diabetic medications).

Post-procedure Instructions

You were given a number of medications during the procedure.  These sometimes include sedatives, narcotics, local anesthetics, steroids, and other medications.  Any of these drugs or procedure itself, sometimes can cause side effects, including drowsiness, temporary numbness, weakness and soreness.

What To Do After the Procedure?

Rest for a few hours and use assistance if needed. Resume activity as tolerated, but do not overdo. Resume regular diet.


Do not drive or operate machinery for at least 12 hours. Do not make important decisions for 12-24 hours after treatment. Walk with assistance as long as numbness, weakness, or drowsiness is present.

Notify If You Have:

Excessive or abnormal bleeding / persistent chills or fever over 100°FIf there is a major change in pain pattern or level.


In case of emergency, call (270) 554-8373.If unable to reach the physician, report to the nearest emergency room and request them to inform the physician at Pain Management Center.

Few Other Things:

Take your usual medication. Apply ice massage as instructed; may use heat if ice is intolerable. If IV site becomes painful, place warm towels on the site for 20 minutes2-3 times / day