Facet joint injections
Facet joint injections contain a strong anti-inflammatory agent called corticosteroid and an anesthetic for pain relief. They are given to relieve pain in the back, neck, arm and leg and even headaches caused from inflammation of the facet joints. Inflammation of the facet joints may occur due to:
- Degenerative disease of the spine such as spinal stenosis, spondylolysis, herniated disc, arthritis and sciatica
- Postoperative acute pain after discectomy and spinal decompression
- Trauma to facet joint because of whiplash injuries of the neck as in a motor vehicle accident or some other traumatic event
Facet joint injections are administered into the inflamed painful facet joints. These are the joints connecting each vertebra of the spine to the vertebra below it and above it. Each vertebra has four facet joints, one pair connects to the vertebra above and the second pair connects to the vertebra below. Thus they are present on both sides of the spine from the neck to the lower back providing flexibility and smooth movement to both the neck and the spine.
Facet joint injections are recommended based on pain patterns and are used to treat pain primarily from the lumbar spine (lower back), thoracic spine (middle-back) and cervical spine (neck).
You will be taken to the pre op area where trained nursing staff will get you ready for the procedure by taking vitals and reviewing your medications. Your blood sugar and coagulation status may also be checked if needed. Then you will enter the procedure room where you will lie, usually face down, on a table. The injection site is cleansed and injection of a local numbing agent is given in the area so that you won’t feel pain during the procedure. A thin hollow needle is then inserted through the skin and muscles to the nerves in the facet joint. The doctor is guided by fluoroscopic X-ray to place the needle in the correct position. This system gives real time X-ray images of the position of the needle in the spine on a monitor for the surgeon to view. A contrast material is then injected through the properly placed hollow needle to confirm that the drug flows to the affected nerve when injected. When the doctor is satisfied with the position of the needle, the anesthetic drug and corticosteroid are injected through the same needle inserted in the spine. You may feel some pressure during the injection but mostly the procedure is not painful. The needle is removed and the injection site is covered with a dry, sterile bandage. One or more facet joints’ may be injected depending on the location of the pain. The time for the procedure will thus depend on the number of facet joint injections required to relieve pain.
Risks and complications
With the use of live imaging though X-ray machines, contrast dye, and physicians trained in the latest interventional techniques, complications are rare. But with all medical procedures, complications may occur. To help minimize risk please follow all directions given to you by your care provider. Have all your treatment options explained, so you are aware of the risks and benefits of these procedures.
Some complications may include:
- Infection: Your physician cleans and sterilizes your back before every procedure to prevent this from occurring. On rare occasions oral antibiotics may be needed.
- Allergic reaction: This may occur if you have allergies to any medication used. Typically this is pre-treated and on occasion your physician may recommend medications for you to take after the procedure. Pay close attention to any rashes and difficulty in breathing because that may indicate need for emergency attention.
- Worsening pain: This may occur after the procedure due to the needle puncture and can last from 3 days to a week. Usually this pain resolves and does not cause any lasting impact.
There are many side effects of corticosteroids. However, by limiting the cumulative dose of medication used, these risks are reduced. Some symptoms you may feel include insomnia, heart palpitations and mood changes.
Facet joint injection may take 2-7 days to show any effect. On recurrence of pain they can be repeated again but the number of these injections you can receive in a 12 month period is limited due to the use of steroids. Your physician will discuss the possibility of repeat injections. If initial facet injection does not reduce pain significantly, repeating the injections may not be helpful and other treatments may be necessary. And as always, follow the instructions of your care provider and have your questions answered prior to the procedure.