Overview
The thoracic facet joints sit on either side of the spine and help guide movement and stability. When these joints become irritated—due to wear and tear, posture, muscular imbalance or injury—they may trigger persistent mid‑back pain. This discomfort can remain localised or radiate around the ribs.
A thoracic facet joint block involves placing local anaesthetic, sometimes combined with steroid medication, around the medial branch nerves that supply the facet joints. This may help reduce inflammation and interrupt pain signals. If a diagnostic block provides good but temporary relief, radiofrequency ablation may be considered to offer longer‑lasting benefit by targeting the same nerves more precisely.
Who this treatment helps
A thoracic facet block or ablation may be considered for people with:
- Localised mid‑back pain or stiffness
- Pain aggravated by twisting, bending or prolonged sitting
- Tenderness over the thoracic facet joints
- Pain following posture‑related strain or injury
- Symptoms that persist despite physiotherapy or medication
- Pain suspected to originate from thoracic facet joints
A consultation is required to confirm suitability and ensure the pain pattern matches facet‑related symptoms.
What is a Thoracic Facet Joint Block/Ablation?
A facet joint block is a minimally invasive procedure that targets the medial branch nerves supplying the facet joints. Local anaesthetic, with or without steroid, is injected to reduce inflammation and provide diagnostic clarity.
Radiofrequency ablation (RFA) uses controlled heat to interrupt pain signals from the same nerves. This may offer longer‑lasting relief in selected cases, particularly when a diagnostic block has been effective.
Fluoroscopy (X‑ray guidance) or ultrasound may be used to optimise accuracy and safety.
What to expect during the procedure
- Your consultant reviews the plan and answers any final questions.
- You lie comfortably on the procedure table, usually face down.
- The skin over the mid‑back is cleaned and numbed with local anaesthetic.
- Using imaging guidance, a fine needle is positioned near the medial branch nerves.
- For a facet block, local anaesthetic with or without steroid is injected.
- For ablation, a specialised needle delivers controlled heat to the nerve for a short period.
- You are monitored briefly before going home the same day.
The procedure typically takes 15–30 minutes.
After the procedure
- Mild soreness or bruising at the injection site is common.
- Temporary numbness or warmth in the mid‑back may occur.
- Pain relief from a block may be immediate due to the local anaesthetic, with steroid effects developing gradually if used.
- Ablation may take several weeks to reach full effect as the nerve signal reduces.
- Most people resume normal activities the next day, avoiding strenuous exercise for 24 hours.
- Your consultant may recommend physiotherapy to support long‑term improvement.
Benefits
May reduce mid‑back pain and stiffness
Can help confirm whether facet joints are the source of symptoms
May improve posture and movement
Minimally invasive with a short recovery time
Ablation may offer longer‑lasting relief in selected cases
Supports rehabilitation and functional recovery
Possible risks and side effects
Thoracic facet blocks and ablation are generally safe. Possible effects include:
- Temporary increase in pain
- Mild bruising or soreness
- Light‑headedness
- Rarely, infection or bleeding
- Very rare nerve irritation
Your consultant will discuss individual risks during your assessment.
When to consider other options
If symptoms persist or if the response is limited, your consultant may discuss:
- Thoracic epidural injections
- Thoracic nerve blocks or PRP
- Trigger point injections for muscular tension
- Physiotherapy or posture‑based rehabilitation
- Medication review
- Combined approaches for complex thoracic pain
Safety note
Please inform your consultant if you take blood thinners, have allergies, diabetes, active infection, are pregnant, or have had previous reactions to steroid or local anaesthetic. You may need someone to drive you home depending on the medications used.
Arrange a consultation to discuss whether a thoracic facet block or ablation may be appropriate for you.