1905 Clint Moore Rd. Suite #309
Boca Raton, Florida 33496
Phone: (561) 988-8988
Fax: (561) 988-7075
FACET BLOCKS AND SACROILIAC (SI) BLOCKS
WHAT ARE THEY?
Cervical or lumbar spine facet blocks and SI blocked are performed for DIAGNOSTIC AND THERAPUTIC purposes. They are performed with a very small needle and contain Lidocaine, a local anesthetic medication, and a steroid that is injected into the spinal facet joints/SI joints. The diagnostic objective is to determine whether they rapidly relieve the painful facet joints/SI joints. Facet joint pain is located just to either side of the spine and often radiates into the trapezius/shoulder/shoulder blade area or even the back of the head; or in the low back which radiates into the flank/buttock/hip area. The SI joints are lower, below the waist, upper buttocks, just to either side of the midline, and this pain can radiate to the buttocks and hip girdle areas, and even down the legs. The steroid reduces the inflammation, which continually provokes pain and the local spread of the anesthetic medication numbs the facet SI joints, providing the pain relief.

RESULTS
If the patient experiences at least 75% relief of the pain within minutes after the injection, particularly upon specific provocative maneuvers which usually produce pain, then the FACET BLOCK / SI BLOCK has been POSITIVELY diagnostic to identify and confirm the painful facet levels or SI joint that is causing the patient’s pain syndrome. The pain relief may only last about 1/2 hour. This is a positive resullt.

INTERPRETATION AND BENEFITS
If the patient experiences less than 75% relief in the first few minutes post-injection, then the facet block is deemed NON-DIAGNOSTIC; and, due to some variations in success rate, the facet block can be repeated at different levels to determine the painful levels contributing to the pain syndrome. Facet blocks/SI blocks can be repeated several times, particularly with steroid to reduce the inflammation. The pain cycle can oftentimes be broken and may not return for months or years, particularly without further injury or provocative activities. Due to the plasticity of the nervous system, breaking the pain cycle on several occasions can often result in longstanding reduction of the pain, much longer, that is, months or years, than the temporary anesthetic effect. This has been demonstrated elsewhere in the nervous system and can occur with facet blocks/SI blocks as well, being a clear benefit to several repeated blocks. If the facet blocks/SI blocks are positive in terms of relieving the immediate pain, but lasting only the duration of the anesthetic, typically a half an hour or so but not on a lengthy basis, and does not seem to definitively break the pain cycle, then the patient will probably be recommended to pursue radiofrequency ablation (RFA) for longer-term relief.

FURTHER PROCEDURES
Radiofrequency ablation involves another needle being inserted along the MB (medial branch), the nerve which innervates the facet joint, the nerve is then ablated under local anesthetic or sedation. The same procedure can be done for the SI joint. This should offer a year or more, sometimes a number of years, of pain relief. Unfortunately, the nerve tends to regrow in a year or two, and so the pain may recur. However, it is the best procedure for relieving this pain on a long-term basis without resorting to surgery, as long as the correct nerves can be identified.

Please be patient, as this can involve several different blocks, even at different levels, as unfortunately, the correct level to inject for these blocks is often not indicated by MRI. Therefore, it is a more difficult diagnostic and therapeutic process to sort through. Usually, however, the procedure of facet blocks/SI blocks and/or eventual radiofrequency ablation does result in lasting pain relief and the beneficial restoration of comfort and function from this pain syndrome.