Wednesday, September 17, 2008

Cervical Facet Blocks: Undercover Investigative Report

***Please note, I have put together an updated overview of my cervical facet block experience. You can see that post HERE.***
Well, I was not undercover. The purpose was not investigative. But, I will report. Actually, the cervical facet blocks I received on Friday, September 12th were so that hopefully, I would receive some relief from the neck and back of the head pain I've been having. But, since I was nervous and a touch scared of the procedure, in order to get through it, I told myself I was an undercover investigative reporter. And here is my faithful report of everything I have learned about the procedure along with my personal experience.

A cervical facet block is also known as a facet joint injection and is similar to an occipital nerve block, but the injection is in a different location. The cervical facet block breaks down to this: cervical= neck, first 7 vertebrae of the spine; facet= paired joints in the spine that provide support and contain tiny nerve fibers; Block= block pain.

Basically a cervical facet block is where the physician injects lidocaine and a steriod (in my case, Decadron) into neck joints in attempt to decrease pain. The physici
an typically uses an X-ray to see where to put the injection.

A great illustration of bilateral cervical facet blocks is found HERE.

I have been having neck pain and back of the head pain since March of this year. My headache/Migraine specialist referred me to a physiatrist that specializes in neck pain. He sent me to a physical therapist. Physical therapy brought me minimal if any pain relief. So, my physiatrist scheduled bilateral cervical facet blocks at the first joint in my spine called occipito-atlanto joint which connects the base of the skull to the spine, between C1 and C2 (first and second vertebrae of the sp
ine) and between C2 and C3 (second and third vertebrae of the spine).

I arrived at the neurological hospital on Friday with sunglasses on. Not just arriving in style, but anticipating the migraine trigger-happy fluorescent lights of the hospital. I checked in at the registration desk, was directed to another floor and eventually my room. The nurse told me I would be taking a pregnancy test because they use a fluoroscope (x-ray) to find the joints during the procedure. I was also asked to change into a very fashionable hospital gown. The surprise came when I was allowed to wear only the hospital-issued socks under my gown! I
asked the nurse why nothing was to come between me and my hospital gown for a neck procedure. She said it was for anesthetic purposes. Germs are carried in on clothes.

An IV was started and I was given IV fluids for the 6 hours I was there. They did a bleed test where they pricked my skin to make it bleed and timed how fast it clotted. They also drew my blood for other tests. I was brought to the pre-op room and the wait continued. 40 minutes later, the anesthesiologist, the nurse and my physician all came to talk to me.

Every time I have talked with this physician, I feel like we are his back porch at a BBQ. He's very laid back, propping his ankle up on his knee. Yet, he explains everything very professionally and is an exceptional listener. He turned off the lights in the whole pre-op area because he recognized they might be bothering me. His calming nature diffused my nerves.

I was wheeled into the operating room and the nurse told me to lay on my stomach with my face in a sponge-like thing with cut out for my eyes and nose. They gave me oxygen via a nasal canula. My arms were at my side, I was wrapped up like a burrito and finally strapped to the table. I wasn't going anywhere. I felt like my IV was pulling and when I mentioned it to the nurse, the anesthesiologist said the medication might be stinging. That was the last thing I consciously remember.

My biggest fear about the procedure is that I would wake up during it. The nurse told me that I would be sedated enough so I would not know what was going on, but would wake if shaken.
The anesthesiologist said I would be taking a good snooze.

I do remember three things that happened during the procedure. But, it was not as though I fully woke up and two of the three remembrances probably happened as I was falling asleep or partially waking up. The first I remember was someone slathering my neck with
something. The second thing I remember was my physician doing something at my neck. The third thing was when I clearly heard people discussing an allergic reaction I was having after I was rolled from the operating table onto the stretcher. But, I did not wake up. I am assuming that is because they gave me IV Benadryl which probably made me sleep more.

I woke up in the recovery room. I was itchy and that is when the nurse explained about my reaction. But, she was not sure what it was to. I still felt very out of it, so when the nurse asked if I was ready to go back to my room, I responded with "I'm cold." I was actually shivering
and my teeth were chattering. She wrapped my head and put a heater on my lap. Later, when I woke up more, they wheeled me up to my room. I was shaky and not stable. But after eating a turkey sandwich, my first meal since the night before, I was feeling a bit better.

Oh, but did I mention, I was SORE! My neck and back of my head felt as though it had been ripped off. I knew I was getting needles in my neck, but oh my. We had to drive home in rush hour traffic, but thankfully the sedating medications were still having some effect. The next two days, I laid in bed all day and was kept up due to pain at night. I could only lay in one position because my back of the head and neck were hurting so much.

So, now, I'm 5 days post-procedure. My neck still hurts. I was told that the steroid could take up to a week to kick in. I'm still waiting. I will see my physiatrist on October 7th to debrief. Treating pain is quite an adventure. I'm definitely learning a lot in the process and I hope to continue to pass that along to you.

(In the picture of my neck, there are only 4 band-aids but I actually got 6 injections, the other two are higher up and towards the outside of my head.)


  1. Oh wow. That's pretty cool. Hope it will kick in soon. Do keep us posted.

  2. Kelly,
    I had this done on my lower back last year. I enjoyed being pain free for about 2 months. The dr wanted it to last longer and wouldn't repeat the ptocedure.

  3. Debbie,
    That is really unfortunate that your dr. wouldn't repeat it especially when it gave you some pain relief! It seems like that is the point!

  4. I hope you get some real relief soon! I've been thinking of doing some "investigating" too regarding my own neck pain, so your post caught my eye. ;)

  5. I wanted to know how you are doing with the headaches you experienced. God Bless you,