If you’ve been dealing with chronic low back pain, one common cause is facet syndrome. This occurs when small joints in the spine become irritated or worn down over time and can contribute to lumbar spondylosis, a term for age-related wear and tear of the spine. This pain is usually in the lower back and may spread to the hips or buttocks. It is often worse with standing, twisting, or bending backward, and may improve with sitting or lying down.

As part of the evaluation, imaging such as X-rays, MRI, or CT scans may be used. Sometimes this shows clear findings, and other times it may not fully explain the pain. Because of that, diagnostic injections are an important way to more accurately test whether these joints are the true source of pain. Evaluation often begins with a medial branch injection, also called a block. The medial branch is the small nerve that carries pain signals from the facet joint. This injection targets that nerve rather than the joint itself.

After the diagnostic injection, pain is reassessed. This is not meant to be a treatment, but a test based on response. The goal is to see pain relief that matches the duration of the numbing medication. If that occurs, it helps confirm the source of pain. This test may be performed or repeated up to two times depending on insurance. However, this is provider-dependent, and in some cases, testing may not be necessary before moving forward.

If appropriate, the next step may include radiofrequency treatment, which encompasses traditional approaches as well as more advanced techniques. A partial facetectomy with nerve avulsion procedure is a more advanced approach compared to traditional radiofrequency ablation. In traditional radiofrequency ablation, heat alone is used to temporarily disrupt the nerve.

With the nerve avulsion approach, a more precise method is used. In addition to heat, a small portion of the nerve pathway is disrupted to create a more consistent interruption of the pain signal.

This may provide longer-lasting relief, potentially for several months to a year and beyond, in some patients while still using a minimally invasive technique. The procedure is performed with imaging guidance, takes less than an hour, and patients go home the same day. There are no sutures, and typically no more than a small bandage is needed. Most procedures are done with local anesthesia only.

If sedation is used, NPO guidelines apply. This usually means no solid food for eight hours and clear liquids, like water or black coffee, up to two hours before, but instructions may vary, so confirm with the care team.

Some patients experience meaningful relief for several months to a year and beyond, but results vary. There are no guarantees. Some patients improve significantly, some partially, and some may not respond.

Risks are generally low but include soreness, bleeding, infection, or temporary nerve irritation. In rare cases, more serious complications can occur, including permanent nerve injury and worsening pain.

Alternative options may include continued conservative care, repeat injections, or other interventional or surgical treatments. This procedure is typically considered after conservative therapies have not provided sufficient relief.