Gateway Midwest Healthcare treats Kirkwood patients for facet joint pain and sacroiliac joint pain, diagnosed by targeted injection rather than by scan, with radiofrequency ablation once the facets are confirmed. The office is about twenty-five minutes away by I-270.
Kirkwood patients most often come to us for the two pain sources that are hardest to identify without image guidance.
Can an MRI show facet joint or sacroiliac joint pain?
The facet joints and the sacroiliac joint account for a large share of persistent low back pain, and neither can be diagnosed from a scan. Degeneration in the facets is nearly universal past middle age, and the sacroiliac joint looks unremarkable on MRI even when it is the entire problem.
So the diagnosis is made by targeted injection rather than by imaging. That is a different kind of appointment from the one most people expect, and it is why a patient can arrive with three normal-sounding scans and leave with an actual answer.
The roads around Kirkwood, and what they send us
I-44 and Lindbergh Boulevard meet at one of the busier interchanges in the county, and Lindbergh’s signalized stretches produce the low-speed rear-end collisions.
Two things follow from that layout. Stop-start commercial strips generate the low-speed impacts that strain facet joints without fracturing anything, and long daily drives generate the cumulative loading that shows up as evening pain rather than as an event.
What we treat most for Kirkwood patients
Facet joint pain
Confirmed by medial branch block, not inferred from a scan.
Sacroiliac joint pain
Invisible on MRI and diagnosable only by image-guided injection.
Medial branch block
The test that establishes whether the facets are responsible.
Radiofrequency ablation
Many months of relief once the joints are confirmed.
What this means for Kirkwood patients in practice
The two-block protocol before ablation is not bureaucratic caution. A single diagnostic block has a meaningful false-positive rate — placebo response, spread of anesthetic to adjacent structures, and simple day-to-day variation in pain all contribute. Confirming twice before a procedure that lasts months is proportionate.
What makes a block positive is specific: substantial relief for roughly the duration of the anesthetic, then return. Partial relief lasting a week is not a positive block; it is a steroid effect, and it tells you something different.
This is also why the pain diary matters and why we insist on it. The result of the test is what you record in the hours afterwards, not what you remember at the next appointment. Without it the block has been wasted and has to be repeated.
Planning the trip from Kirkwood
For Kirkwood patients the work most often centers on facet joint pain, sacroiliac joint pain, medial branch block and radiofrequency ablation. Each of those has its own page setting out how it is diagnosed here and what treatment actually involves, and reading the relevant one before the appointment tends to make the visit more productive.
Allowing about twenty-five minutes by I-270 each way, we try to make every visit earn the journey. That usually means combining assessment and procedure where it is clinically sound to do so.
Please bring imaging, medications and a short history of previous treatments with their outcomes. Where records exist elsewhere, telling us in advance lets us request them before you travel.
Twenty-five minutes each way supports the two-block diagnostic sequence properly, which matters: the blocks have to be spaced and each one needs its own pain diary.
We also see patients from Webster Groves, Des Peres and Sunset Hills. The full list is on areas we serve.
To book, call or text us. Monday to Friday, 8:00 a.m. to 4:00 p.m. We are at 12174 Natural Bridge Rd, Suite 110, St. Louis, MO 63044 — about 25 minutes from Kirkwood, St. Louis County. No referral is needed to book and no attorney is needed to be treated after an accident.
How is facet joint pain diagnosed?
Facet joints are small paired joints at the back of each spinal segment. They are among the most common sources of persistent neck and back pain, and they cannot be diagnosed from a scan, because degeneration in them is nearly universal past middle age.
The confirmation is a medial branch block: a small volume of anesthetic placed at the nerves supplying a specific joint. If those joints are producing the pain, the pain goes for roughly the duration of the anesthetic and then returns. That return is not a failure; it is the result.
Two blocks are standard before proceeding to ablation, because a single block has a meaningful false-positive rate from placebo response and spread of anesthetic to nearby structures. Confirming twice before a procedure that lasts months is proportionate.
Questions we get from Kirkwood
Why can a scan not tell you if my facet joints hurt?
Because facet degeneration is present in most adults regardless of pain. Only a targeted block answers it.
See Medial Branch Block.
What is the pain diary for?
It is the actual result of the block. Without it we cannot tell whether the test was positive and it has to be repeated.
There is more on this in Medial Branch Block.
How long does the relief from ablation last?
Commonly six to twelve months. The nerves regenerate and the procedure can be repeated.
Why do I need the same block twice?
One block carries a real false-positive rate. Two agreeing results make it far more likely the joints are genuinely responsible.
What counts as a positive block?
Substantial relief for about the duration of the anesthetic, then return. Partial relief lasting a week is a steroid effect and means something different.
What is a medial branch block?
It is a diagnostic test. Using image guidance, a small volume of anesthetic is placed at the nerves that supply a specific facet joint. If that joint is producing your pain, the pain goes away for roughly as long as the anesthetic lasts and then comes back. That return is not a failure; it is the result, and it tells us whether the facets are responsible.
What happens after a medial branch block?
In the hours after the block you record your pain in a diary, because that record is the actual result of the test. If the relief is substantial and lasts about as long as the anesthetic, a second block is spaced out and recorded the same way. Two agreeing results confirm the facet joints, and radiofrequency ablation is the next step.
What is the best treatment for facet joint pain?
Once two medial branch blocks confirm the facet joints as the source, we treat them with radiofrequency ablation. The relief commonly lasts six to twelve months, because the treated nerves slowly regenerate, and the procedure can be repeated when the pain returns. Confirming the diagnosis first matters, because degeneration in the facets shows up in most adults whether it hurts or not.
12174 Natural Bridge Rd, Suite 110
St. Louis, MO 63044
The map loads from Google, which sets its own cookies. We do not load it until you ask.
Hurt in an accident? Start here.
You do not need a lawyer, a police report or a referral to be seen. Bring your symptoms and we will work out the rest.
Monday–Friday, 8:00 a.m. – 4:00 p.m. Same-day appointments are often available for new accident and injury patients.