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Spine
Published in David A Lisle, Imaging for Students, 2012
Indications for medial branch block include:Recurrence of symptoms following successful facet joint block.Confirm facet joint as pain generatorPrior to permanent medial branch ablation.
Guidelines for the Practice of Interventional Techniques
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Laxmaiah Manchikanti, Vijay Singh, Andrea M. Trescot, Timothy R. Deer, Mark V. Boswell
Therapeutic facet joint blocks are based on the outcome of a diagnostic facet-joint block, with the patient obtaining sufficient relief for a meaningful period of time; but when pain recurs, a repeat block using a small dose of local anesthetic and steroid provides longer-lasting relief (4 to 8 weeks).
Use of lasers in minimally invasive spine surgery
Published in Expert Review of Medical Devices, 2018
Facet syndrome or facet joint arthritis is one of the major etiologies of low back pain for which surgical intervention might be applied [55,56]. Lumbar facets or zygapophyseal joints are synovial arthroses richly innervated with nerve endings from the medial branch of the posterior primary ramus [57]. Current treatment options include facet joint block or medial branch block for short-term pain relief and facet joint denervation for long-term pain relief by radiofrequency or cryotherapy. The results of facet joint denervation or rhizotomy have been variable, with many patients requiring repeated procedures or experiencing inadequate pain relief. Some authors have reported laser facet denervation techniques [56,58,59]. The patient is placed prone on the radiolucent table. Under fluoroscopic guidance or endoscopic visualization, the Ho:YAG straight-firing laser probe is directed at the medial branch or the dorsal ramus, the nerve that gives rise to the articular branches at each level. Each facet joint is innervated from above and below the segments. The laser probe can be also directed to the facet joint itself. The target points are the lower, middle, and upper portions of the facet joint. The total irradiation energy at one facet is about 500–600 J. Laser has the advantage of coagulating a relatively larger area in the vicinity of the probe tip compared with a radiofrequency probe. Laser facet denervation can be applicable and efficient for patients who failed to be relieved by block or radiofrequency facet rhizotomy.
Air embolism following peripheral intravenous access
Published in Baylor University Medical Center Proceedings, 2019
Myrian Noella Vinan-Vega, M. Rubayat Rahman, Jeremy Thompson, Misty D. Ruppert, Raj J. Patel, Amr Ismail, Sara Mousa, J. Drew Payne
In this case, the patient had onset of neurological symptoms shortly after a facet joint block. Air embolism has been reported following hip and greater trochanteric bursa injections but has not been encountered as a complication of facet joint blocks.10 Intravenous access was difficult to obtain for sedation prior to this patient’s facet joint injection. She had no other history of recent intravascular interventions, indicating that intravenous access was the most likely source of the air embolism.