Facet Arthritis/Spinal Arthritis – Treatment Lumbar Medial Branch Blocks

 

Facet joints are small paired joints located in the posterior aspect of the spine. These joints are critical for spinal stabilization and motion.  The joints are innervated by nerves called medial branch nerves.  The nerves carry sensory (touch and pain) and proprioceptive (position sense) information to the brain.

 

 

Facet arthritis is caused by the breakdown of cartilage between the facet joints located in the posterior aspect of the spine.  In many instances, facet joint arthritis is caused by the thinning of the intervertebral discs which place excess stress and pressure on the facets which can accelerate arthritis in the facet joints.  When these arthritis facet joints move, the lack of cartilage between the joints causes pain and stiffness. Facet Arthropathy or Lumbar Spondylosis are other terms used to describe facet joint arthritis.  The application of local steroids into the facet joints may provide some local relief of the pain from facet joint arthritis, but repetitive steroid use is not recommended as persistent exposure to steroids over time can have deleterious effects on multiple body systems.

 

 

Multiple examples of facet joint arthritis

Lumbar Medial Branch Blocks

An effective treatment in the management of facet joint arthritis pain is a procedure called lumbar medial branch blocks.  Lumbar medial branch blocks are an image-guided fluoroscopic procedure where a needle is used to inject an anesthetic on the lumbar medial branch nerve to block the pain signal from reaching the brain.  Lumbar medial branch blocks are a diagnostic procedure that can help the clinician to know the source of the patient’s pain. In the image to the left, spinal needles are positioned on top of the lumbar medial branch nerves (not seen).  The clinician will then inject anesthetic on top of the medial branch nerves to block the nerves.  The patient will then complete a pain inventory to assess if the low back pain reduces on the treated side.

 

If lumbar medial branch blocks are effective, the clinician can move to complete a radiofrequency ablation for back pain of the medial branch nerves which can greatly improve a patient’s pain, mobility, and function without surgery.

 

 

Lumbar Medial Branch Nerve Blocks Fluoroscopic Images