Cervical (neck) and Lumbar (low back) Facet Joint Nerve Block FAQ’s


Is there a lot of radiation involved?

No. Fluoroscopy uses low intensity x-radiation which is only useful to track the needle position. For each procedure the total radiation is less than a chest x-ray and much less than a CT scan. Women of child bearing age will be asked about last menstrual period and will be asked concerning pregnancy. If there is any chance of pregnancy the test will be postponed.

Does Lidocaine or EMLA cream placed on the skin before the procedure reduce the pain of the procedure? 

Yes, to some extent. The cream should be placed according to the diagrams below and covered using clear plastic wrap such as kitchen clear wrap. If the cream is on the skin for two hours or more then the skin will be insensitive. However the other tissues down to the facet joint nerves themselves will not be frozen until the needle is inserted. Therefore the cream will not reduce most of the pain of the injections. The cream is not mandatory.

What is injected?

It will be a local anesthetic. No cortisone or steroid or placebo is ever used for the facet joint nerve block.

Which local anesthetic is used? 

This will be a powerful local anesthetic similar to that used by the dentist or in the emergency room to freeze a cut for suturing. The name will not be revealed. This is to prevent the patient from knowing the exact duration of action of the local anesthetic. It is important that the patient fill in the pain scoring sheet according to how he/she feels and not according to any predetermined expectation of how long it should last.

How do I prepare for the injections?

You may eat and drink normally. Shirts with tightfitting collars may have to be removed for cervical facet joint procedures. The patient will not be required to remove any shirt with a loose collar but it may be taped to prevent it from entering the area of the injection. No other special clothing is required.

Please have a list of your medications and your allergies. All medication taken for other medical conditions should be taken as usual. This includes blood pressure medications, heart medication, cholesterol medication and others. Please inform the physician if you are on anti-coagulants which could increase your chances of bleeding and bruising. Long acting pain medication should be taken as usual. Short acting pain medication such as Percocet, Tylenol #3, Tramacet, Statex, etc should be avoided within 4 hours of the test.

It is important to have a driver so the patient will not have to drive home after the test for reasons given above. Public transportation is acceptable.

Will I have the procedure on the day of my assessment with Dr. Shulman?

In most cases, yes. The reasons for not having the procedure are:

  • The patient declines.
  • There is active skin infection at the site of the injections.
  • There is an infection anywhere in the body causing a fever.
  • There is suspected allergy to local anesthetics.
  • The patient may be pregnant.
  • The patient has a pain score less than 4, out of ten.

Occasionally patients have good days when the pain is mild and the pain score is less than 4 out of ten. In this case it is very difficult to interpret the result and it is best to postpone the procedure. If it appears that the pain score will be less than 4 please do not attend and inform my secretary at the earliest possible time. There is no penalty for cancellation of the procedure the same day or last minute. However, the earlier you cancel the more opportunity we have for advising another patient to attend in your place. We will do our best to reschedule your appointment at the next available date.

Where can I read more?

Please explore the sites on the Web. In many sites facet joint nerve blocks are called medial branch blocks. Consider these the same thing.  One site with a video is:

Click here to play video

Please do not hesitate to contact me, Dr. Shulman, through my secretaries Bella and Lana at my office (905) 886-1212 extension 103 prior to the procedure or afterwards for additional information if required.

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