Facet Medial Branch Block

Diagram showing the degeneration in the lumbar spine

Just like any joint in the body, the facet joints can become inflamed due to arthritis and degeneration. This can cause pain and stiffness, which often worsens after rest, first thing in the morning, or after prolonged sitting or standing. Changing position may improve symptoms, though sometimes muscle spasm and sharp pain can occur.

About the Procedure

The procedure can be performed with either local anaesthetic or intravenous sedation (so you are drowsy or asleep). You will be asked to lie on your stomach on the operating table, with your head to one side. The skin over your back is cleaned with antiseptic solution.
Live X-ray (fluoroscopy) is then used to accurately position a fine needle next to the medial branch nerves. A small amount of local anaesthetic, and sometimes corticosteroid, is injected. Several nerves may be treated in the same session. The whole procedure usually takes only a few minutes.

This is a day case procedure, meaning you can usually go home the same day. Temporary numbness or weakness may occur until the local anaesthetic wears off. Pain may briefly worsen before the steroid takes effect, which can take several days to weeks.

Pre-operative assessment

a member of the pre-operative team will contact you to discuss important details and assess your fitness for surgery. They will ask about your medical history, any current medications, and allergies, as well as answer any questions you may have about the procedure. This step ensures that the surgical team has all the necessary information to plan your care safely. In some cases, you may also be invited to attend a pre-assessment clinic, where additional checks can be carried out to confirm that you are ready for the procedure

Fasting

It is essential to follow the fasting instructions before your procedure. You must stop eating solid food 6 hours before the operation. Clear fluids such as water, black tea, or black coffee (without milk) can be consumed up to 2 hours before your procedure. However, nothing should be eaten or drunk in the final 2 hours before the procedure. These guidelines are very important to reduce the risk of complications related to sedation or anaesthesia.

Risks and Complications

Facet medial branch blocks are generally safe. However, like all procedures, there are small risks:
• Temporary numbness, tingling or weakness in the back or legs

• Bruising or soreness at the injection site

• Facial flushing or changes to menstrual cycle (steroid-related, temporary)

• Increase in blood sugar for a few days (in people with diabetes)

• Allergic reaction to medications or contrast dye (if used)

• Rarely, headache due to irritation of the spinal lining and minor leakage of spinal fluid

• Risks of sedation: drowsiness, low blood pressure, nausea, temporary memory impairment, slower breathing (carefully monitored by your anaesthetist)
It is also important to let your consultant know if you are taking blood-thinning medicines (such as warfarin, rivaroxaban, clopidogrel or aspirin), as these may need to be stopped before the injection.

What to Expect on the Day

You may be admitted early so your anaesthetist and consultant can see you before the procedure. You will be taken to theatre, where the injection will be performed. Afterward, you will be observed in the recovery ward, where your blood pressure and pulse will be monitored. If sedation was used, oxygen may be given while you wake up.
Most patients are able to go home the same day, after having something light to eat and drink.

Going Home

You will normally be discharged within 1–2 hours of the procedure. If sedation was used, you must not drive for 48 hours and a responsible adult should stay with you overnight.
It is important to continue your usual pain medications until you feel the benefit of the injection. Do not stop strong painkillers (such as morphine, gabapentin, pregabalin or amitriptyline) suddenly – your GP or consultant will advise you on tapering them if necessary.

Driving

Do not drive until you feel confident you can safely perform an emergency stop. If you have persistent numbness, weakness, or pain, you should wait longer. Most patients can return to driving within a few days.

Work

If you had sedation, you should take at least the following day off work. Some patients may require longer, depending on their recovery and level of pain relief. The hospital can provide a medical certificate if needed.

Follow-up

Your consultant will arrange a follow-up appointment. If you experience good but temporary pain relief, a longer-term treatment such as radiofrequency denervation may be offered. This uses heat to deliberately interrupt the medial branch nerves, which can provide months or years of benefit.
Eighty percent of patients experience significant improvement with injections, though the duration of benefit varies. For some, the relief may last only weeks, for others, much longer. If effective, the procedure may be repeated after several months if necessary.
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For further information / contact us
Mr Al-Mahfoudh’s PA
07501 703075
secretary@spineandbrain.co.uk

Pre-operative team at Spire Gatwick
01293 306 122
gphpre-assessment@spirehealthcare.com

Pre-operative team at Spire Montefiore
01273 829 350
montefioreadmissionspsc@spirehealthcare.com