What Is A Lumbar Facet Block?

A lumbar facet block is a common non-invasive procedure used to treat lower back pain.  If left untreated, lower back pain can become chronic and may lead to eventual loss of mobility. Lumbar facet blocks are routinely performed on patients who have not had success with opioid treatment and non-steroidal anti-inflammatory drugs (NSAIDs). They are also used as part of a conservative pain-management program to help treat patients who may not be suitable candidates for surgery due to certain health conditions.

Along with the goal of reducing pain-causing inflammation, physicians often perform lumbar facet blocks to help locate the source of a patient’s lower back pain.  Pain relief from the lumbar facet block confirms that the suspected joint was the source of a patient’s pain.  However, if the injection fails to reduce or eliminate the pain, additional diagnostic tests may be needed to help locate the potential source of pain.

There have been several studies about the use of lumbar facet injections for lower back pain. The results of these studies have revealed that along with enhanced pain control, lumbar facet blocks offer patients increased range of motion and an associated substantial improvement to a patient’s quality of life.

One particular investigation, which was reported in a 2009 edition of Pain Physician, involved a two-year reexamination of patients who had received previous diagnostic lumbar facet blocks. During this follow-up, researchers examined patients for degeneration of the facet joints. The ultimate results of this study revealed that the diagnostic lumbar facet blocks successfully identified the facet joints as the cause of pain in approximately 93% of the patients following a one-year period, and about 89.5% after two years.  In another recent study, researchers observed patients for nine months after receiving lumbar facet blocks for lower back pain.  At the conclusion of this study, 74% of patients received pain relief from the facet blocks.

Lumbar facet blocks relieve pain and facet joint inflammation through the injection of an anesthetic and a potent anti-inflammatory steroid into the affected joint. These inflammation-fighting steroids have been used since the 1950s to treat inflammatory conditions, such as facet joint pain and other degenerative bone diseases. The steroids help reduce inflammatory mediators by binding to the nucleus of a cell.

Physicians have several choices of steroidal medication to choose from when performing facet block injections.  After the injection, pain relief usually occurs within one to two days and can last from a couple of days to as long as six months.  If the procedure successfully reduced or eliminated the patient’s pain, additional injections may be performed.

How Is A Lumbar Facet Block Performed?

The basic anatomy of facet joints help illustrate how this procedure is performed on patients. The facet joints, also known as zygapophysial joints, are bony knobs, which are located on both sides of the spine. They are separated by a layer of cartilage and are also surrounded by a capsule that is filled with synovial-lubricating fluid. Degenerative alterations within these joints are often the source of chronic lower back pain. The goal of a lumbar facet block is to relieve this inflammation through the injection of steroids.

Lumbar facet blocks are performed in outpatient settings with a reasonably short treatment time. Before the injection, the patient is comfortably positioned facedown on an X-ray table in order for the physician to have clear access to the injection site.  The patient’s skin at the injection site is thoroughly cleaned with an antiseptic solution. If IV sedation is utilized, the patient’s vital signs, such as heart rate, blood pressure, and respiration, will be closely monitored.

The physician then uses fluoroscope guidance to assist with correct placement of the needle into the joint. A local anesthetic along with the steroid injection may also be used to help with the pain-relieving effects of the injection into the facet joint.  Following the procedure, a band-aid is placed on the injection site. Medical personnel will then move the patient to a recovery room. The patient will be monitored short-term for the effects of the procedure.

Patients may feel immediate pain relief due to the injection of the local anesthetic with the steroid medication. This relief is temporary and caused by the anesthetic medication. The longer-lasting pain relief from the steroid medication usually takes a couple of days to start working. After the lumbar facet block, patients are encouraged to rest and keep activity to a minimum for at least 24 to 48 hours. If the patient notices swelling at the site of the injection, ice may be applied as necessary.  If swelling is present, it typically decreases within a couple of days after the procedure.

Lumbar facet blocks are standard procedures; however, potential side effects or complications may include headaches, nerve damage, infection, allergic reaction, bleeding, and temporary tenderness at the site of the injection.

Conditions Related To Lumbar Facet Blocks

Research has shown that lumbar facet blocks have demonstrated successful results in treating pain associated with chronic lower back pain. The procedure has also proved successful in its diagnostic capacity in identifying the potential source of pain.

Lumbar facet blocks may be administered to treat lumbar facet syndrome caused by degeneration of the facet joints. Lumbar facet syndrome usually manifests as pain in the lower back area that radiates to the hips and buttocks. The pain usually worsens during movements that cause the spine to extend.

One of the benefits of steroidal joint injections over oral steroids is that they may reduce some of the typical complications associated with oral steroids, such as skin thinning, peptic ulcerations, aggravation of diabetes, and muscle weakness.

Conclusion

Research has helped to support the theory that patients with chronic lower back pain are viable candidates for lumbar facet blocks. Lumbar facet blocks also play a mitigating role in helping to diagnose the source of lower back pain.  In this dual capacity, they offer pain relief while simultaneously helping the patient to make an informed choice regarding future treatment options. The ultimate goal of lumbar facet blocks is to improve a patient’s mobility and quality of life while potentially avoiding back surgery.

References

  1. Manchikani L, Singh V, Falco F, Cash L, Pampati V. Evaluation of lumbar facet-joint nerve blocks in managing chronic low back pain: a randomized, double blind, controlled trial with a 2-year follow-up. Int J Med Sci. 2010;7(3):124-135.
  2. Pampati S, Cash K, Manchikani L. Accuracy of diagnostic lumbar facet joint nerve blocks: A 2-year follow-up of 152 patients diagnosed with controlled diagnostic blocks. Pain Physician. 2009;12:855-866.
  3. Peh WCG. Image-guided facet joint injection. Biomed Imaging Interv J. 2011;7(10):e4.
  4. Riew KD, Park JB, Cho YS. Nerve root blocks in the treatment of lumbar radicular pain. A minimum five-year follow-up. J Bone Joint Surg AM. 2006;88(8):1722-1725.
  5. Shah S, Shah A, Askar Z, Ahmad I, Gillani U. Evaluation of outcome of facet joint injections in low back pain. Pak J Med Sci. 2010;26(4):892-896.