Facet Joint Denervation
What is a facet joint?
The facet joints are located at the back of the spine on both sides of the vertebrae where one vertebra overlaps the next vertebra. The facet joints provide stability and give the spine the ability to bend and twist. The joints are surrounded by a joint capsule, which contains lubricating liquid. These joints are located throughout the spine and are known to be a source of pain in many patients.
What is facet joint denervation?
Facet joint denervation involves heating the nerves supplying the joints with a special needle with a tip that could be heated. It is used to treat spinal pain. This procedure is done after you have had a positive result from a diagnostic test injection known as a facet joint nerve block or medial branch block. This procedure works best if most of your pain is coming from your facet joints. However, if your pain is coming from other tissues around your spine like the discs or ligaments, this procedure may only be a partial success, or may not work at all, despite the diagnostic test being positive.
How is it done?
Facet joint denervation is performed as a day case procedure. You will be admitted to Jefferson Day Ward and seen by one of the pain doctors who will ask you if you have any further questions. Shortly before your turn to go into theatre, you will need to change into a hospital gown and a mark will be placed at the proposed side of the injection. The procedure will be carried out in the operating theatre under X ray guidance.
The theatre staff will guide you to the best position on the theatre table. You will lie on your tummy and for procedures in other parts of your spine you may either be on your side or back. A plastic cannula (needle) will be placed in the back of your hand and light sedation may be given to relax you, if requested and agreed by your consultant. Deep or heavy sedation is not recommended as it can compromise safety and effectiveness of this procedure. We will monitor your breathing and circulation. A member of theatre staff will sit with you and reassure you, if you feel anxious. The area where denervation is being carried out will be cleaned with antiseptic solution.
This procedure is performed using X rays. Local anaesthetic is first injected into the skin and the muscles underneath to numb the area. Nerves supplying the facet joints are located by passing a mild electrical current through a special needle or by checking on x ray to see if the needle position is satisfactory. Once the needle is in the correct location, the needle tip is electrically heated to numb the nerve. Several nerves may be numbed in this way.
There may be some discomfort during this procedure, despite using local anaesthetic. After the procedure is done, the needle is withdrawn, and a small dressing will be applied at the site of injection, which can be removed after 24 hours. Do not worry if it falls off sooner.
- There is a very rare chance of nerve injury leading to numbness or permanent limb (arm or leg) weakness despite the consultant testing for sensation or twitching before this treatment.
- It is not unusual to have an increase in pain for 2-4 weeks and it settles with simple pain killers.
- This procedure can cause temporary pain and bruising at the site of the injection.
- You may develop new pain in your limb after the procedure which usually resolves after a few weeks, but this is rare.
- There is a chance that this procedure may not work or make your pain worse for up to 3 to 4 months or even longer, but, this is very rare.
If you would like further information or you would like to discuss this procedure again with a doctor please contact your consultant’s secretary by phone (The Walton Centre 0151 525 3611)
- Last Updated:01 April 2018
- Review Date:01 April 2022
- Author:Pain Team
Facet joint denervation involves heating the nerves supplying the joints with a special needle with a tip that could be heated.