Facet blocks for relief of chronic back and neck pain has been performed by physicians for many years.It has evolved the way so many procedures have to become more specific and diagnostic as well as still serving its therapeutic value to the patient.Current thinking dictates that facet blocks should be performed using fluoroscopic guidance to ensure correct needle placement during the procedure.
Facet blocks can be performed essentially anywhere along the spine, including cervical, thoracic, lumbar, sacral, and caudal, depending upon where the pathology dictates.
The facet joint is a synovial joint (which means lined by synovium - cells that secrete lubricating fluid) and represent where one vertebrae contact the vertebrae directly beneath. There is a facet joint on each side of the spine, right and left.
When these joints become enlarged (facet hypertrophy) or inflammed, they can irritate or compress spinal nerve roots that are located directly in front of each facet joint. The pain symptomatology seen typically with facet related pain is para-axial (along the side of the spine) and without significant radicular component. It is exacerbated by extension of the spine, twisting movements, and rarely radiates past the knees.
The decision of when to perform facet blocks is a clinical judgement on the part of the physician when taking into account the patient’s pain and neurologic complaints and symptoms, physical examination findings, imaging studies, such as MRI or CT scan, and historically if any of these techniques have been tried already and the results they have had in controlling the patient’s pain.