Facet joint denervation

Your facet joints play the role of connecting each bone in your spine and promoting healthy movement and stability in this area. You use these joints whenever you bend or twist your spine, whether it's while playing a sport or when picking something up off the floor.

Over time, this constant use can lead to the breaking down and swelling of your facet joint's cartilage - the tough, flexible protective lining around your joint that facilitates smooth movement. When this happens, your joints rub against each other, meaning pain signals are triggered in the nerves that connect to your facet joints, known as your medial branch nerves, which can lead to the following symptoms:

• A dull aching pain in your lower back
• Pain that spreads to your buttocks
• Difficulty bending backwards or twisting sideways
• Pain gets worse after standing or periods of inactivity
• Your pain eases when you sit, lean forward, or change positions to ease pressure on your facet joints
• Pain down the arms and legs

Facet joint pain can be constant, or it can flare up periodically. You are most likely to experience discomfort in your lower back area, given that the facet joints located in your lower back (or lumbar spine) bear most of the weight and greatest amount of strain. It is also possible to experience pain in your neck due to facet joint damage in this area.

Anyone can experience facet joint pain, but it is most common if you are 40 years old or older, given that the cartilage covering your joints wears down over time. This is especially the case if you have osteoarthritis or rheumatoid arthritis, both of which speed up the process of joint degeneration and subsequent pain. Other factors like spinal injuries, obesity, poor posture, or other spinal conditions can also increase your chances of developing facet joint pain.

Your consultant will start by getting some information about your back or neck pain. They may ask about how long the pain has been going on for, what started it, what kind of pain you feel (constant or periodic, sharp or dull, etc.), and whether anything improves it or makes your condition worse. It is possible that they may ask to conduct a physical examination, which involves asking you to do certain range of motion exercises and seeing where and when you feel any discomfort. They may manipulate your joints or feel for tenderness over your spine as well.

To check whether your pain is caused by another spinal problem, your consultant may also do some imaging tests, such as an X-ray. While not producing images of your joints, this test can show whether the space between your vertebral bones (spinal bones) has been reduced due to joint inflammation or bone spurs (bony lumps that can form due to pressure on your joints). An MRI scan may also be used, as this gives your consultant clear images of your soft tissue (joints, cartilage, etc) and whether there is any inflammation around your facet joints.

If you have not had any treatment for your facet joint pain before, your consultant will most likely start by recommending a series of non-surgical treatments. These may include:

Rest and anti-inflammatories

The first thing your consultant will recommend is to avoid the movements that lead to your back or neck pain, along with taking anti-inflammatory medications (NSAIDs), such as ibuprofen or naproxen, to bring down the swelling in your facet joints. If your pain is not too severe, or has only just started, it is possible that this may be enough to address your symptoms.

Physiotherapy

Guided physical exercises can be helpful for treating facet joint pain. Your physiotherapist may give you some range of motion exercises, along with instructing you on proper lifting and walking techniques, which helps to protect your inflamed joints while also strengthening the muscles around the affected area, giving your body more ability to cope with pressure on either your lower back or neck area in the future.

Medial branch block

Before your consultant recommends facet joint denervation, you will need to have another procedure known as a medial branch block. This treatment involves your consultant making an injection of local anaesthetic close to the medial nerves that are linked to and supply your painful facet joint. If this injection notably reduces your back or neck pain for at least two days, they will be able to confirm that your pain is definitely coming from your facet joint, meaning that facet joint denervation should be effective in dealing with your discomfort.

Ahead of your facet joint denervation procedure, your consultant will speak to you about how you can prepare for your visit to hospital.

Check medications

Your consultant may ask you to stop taking certain medications ahead of your facet joint denervation treatment. Any blood thinning drugs, such as warfarin, aspirin, or anti-inflammatories, may cause complications during or after the procedure, so you'll need to pause these two weeks before coming to the hospital.

You should also let your consultant know if you're diabetic, pregnant, have a cough, cold, or any kind of infection.

Arrange a lift home

You won't be able to drive after your facet joint denervation procedure, nor will it be advisable to take public transport. So, prior to your procedure, please arrange for a family member, friend, partner, or taxi service to give you a lift home. If possible, have someone nearby for the first 24 hours after your treatment so that they can take care of any errands like shopping or dropping children off at school.

Food and drink

Your consultant will ask that you avoid any food and drink (apart from small sips of water) eight hours before your procedure. Please also refrain from drinking alcohol the night before.

Your facet joint denervation procedure will be performed with local anaesthetic being applied to the area, which means you won't feel anything apart from a small tingling feeling when the injection is made.

This is an outpatient procedure that takes around 30 minutes from start to finish; you'll be able to go home on the same day. The procedure will follow these steps:

• You will be asked to lie face down on the treatment table
• Your back will be cleaned with antiseptic solution and then numbed with a local anaesthetic
• Your consultant will be using an X-ray and radiofrequency generator machine to ensure they correctly identify the location of the nerve that links to your facet joints and is causing you pain
• They will run a series of electrical tests, which guarantee that the specialist needle used for the procedure gets as close to your medial nerve as possible, with the final test being to confirm that the needle tip is nowhere near your main spinal nerve
• Once your consultant is satisfied with the positioning of their needle, some local anaesthetic will be injected into the area, followed by a high frequency electrical signal being passed down the needle for a total of 90 seconds (you may feel some slight discomfort here). This radiofrequency heats it to around 80 degrees, which guarantees that the nerve has a permanent lesion and no longer has the ability to transmit pain signals

Usually, you won't need to take time away from work when recovering from a facet nerve denervation procedure. You should be able to resume daily activities almost immediately.

Everyone responds differently to treatment; it could be that you feel fine straight away or continue to experience pain and need to rest for a week or so. How you respond to treatment may be influenced by a range of factors, such as:

• Your fitness levels
• Your everyday activities
• The nature of your job
• General health
• Your age

After the treatment, you'll be monitored in a private recovery room for about 30 minutes, with your nurse checking your blood pressure and pulse, along with asking if you're having any side effects. In most cases, you'll be able to go home one to three hours after your facet nerve denervation procedure.

There is a chance that you'll feel some pain afterwards, which is normal. It could last for one or two weeks, and may get worse before it gets better. You will be given pain relief medication to use whenever you need it. Once your pain improves, you can gradually increase your level of activity, although be careful about doing too much. Your consultant shall speak to you about what physical activity you are safe to do after your procedure.

Like with any treatment, some complications are possible, but these are very rare. Your consultant will explain all the risks of facet joint denervation to you before arranging your visit to hospital, giving you the chance to ask any questions you might have.

General complications of any operation:

• Pain
• Bleeding
• Infection in the surgical wound
• Unsightly scarring
• Blood clots
• Difficulty passing urine
• Chest infection
• Heart attack or stroke

Specific complications of facet joint denervation

• Soreness or bruising at your injection site
• Pain gets worse for a few days or weeks
• Pain doesn't improve
• Anaphylaxis (severe allergic reaction to medications used)
• Temporary numbness and weakness
• Injury to your main spinal nerve, causing tingling, numbness, weakness, or pain
• Spinal cord damage
• Stroke
• Menstrual disturbance due to the steroids used during treatment

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations to suit your routine
• The freedom to choose which hospital and consultant best fits your needs
• Personalised, consultant-led treatment plans adapted to your particular requirements
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private cosy ensuite rooms as standards and delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about facet joint denervation, or receive support for nerve-related conditions of any kind, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in January 2023. Next review due January 2026.

1. Radiofrequency facet joint denervation, NHS Foundation Trust
2. Lumbar radiofrequency facet joint denervation, AOMRC
3. Radiofrequency denervation, Bupa
4. Facet joint radiofrequency denervation treatment, London Pain Clinic
5. Facet joint syndrome, Mayfield Clinic