Facet Joint Injections

Facet Joint Injections Overview

A facet injection is a minimally invasive procedure that can temporarily relieve joint or nerve pain caused by inflamed facet joints. Facet joints are involved in carrying weight through your back/neck and allowing motion of the spine including flexion, extension and twisting.

Facet mediated pain is often felt as a deep aching sensation in the back or neck that is worse with movement.

Facet joint pain can be caused from numerous factors including arthritis, degenerative disc disease, falls and car accidents. Pain from the facets cannot be diagnosed by x-ray, CT scan, MRI or Bone scan.

What is a Facet Injection?

A facet injection is a minimally invasive procedure that can temporarily relieve joint or nerve pain caused by inflamed facet joints. Using precision guidance a small amount of steroid and local anesthesia is placed directly into each joint suspected of producing pain. A facet injection has two potential purposes. First, it can be used as a diagnostic test to see if the pain is actually coming from your facet joints. Second, it can be used as a treatment to relieve inflammation and pain. Pain relief may last for several days to years, but 3-4 months is average. The goal is to reduce pain so that you may resume normal activities and a physical therapy program.

Prior to the Procedure

Patients who take blood thinner medication ( Coumadin, Heparin, Plavix, Ticlid, Fragmin, Orgaran, Lovenox, Innohep, High-dose aspirin) may be requested to stop their medications prior to the procedure. You must obtain approval from your prescribing physician prior to stopping any medication.

If you think you may be pregnant or are trying to get pregnant, please tell the doctor. Fluoroscopy x-rays used during the procedure may be harmful to the fetus.

Sedation is rarely necessary or used, but if it is used you must take nothing by mouth for 4 hours prior to the procedure.

Day of the procedure:

  • Plan to arrive 30 minutes before your scheduled appointment time.
  • We recommend that you have something light to eat to the appointment.
  • Make arrangements to have someone drive you to and from the office the day of the procedure.
  • The procedure generally takes 15-30 minutes followed by a recovery period.

Step 1: Prepare the patient

The patient lays face down on the table, the skin is cleaned and the skin is numbed with a local anesthetic.

Step 2: Insert the needle

With the aid of a fluoroscope (a special X-ray), the doctor directs a needle through the skin to the area of the facet joints. Fluoroscopy allows the doctor to inject contrast and ensure correct placement of the needle.

Step 3: Inject the medication

When the needle is in place, the medications are delivered on to each facet joint. The needle is then removed.

Step 4: Recovery

Most patients can walk around immediately after the procedure. After being monitored for a short time, you usually can leave the office or suite. Someone must drive you home.

After the procedure

Typically patients resume full activity the next day although we do recommend ‘taking it easy’ for 2-3 days after the procedure. Soreness around the injection site may be relieved by using ice and taking a mild analgesic (Tylenol). The patient may resume taking all medications immediately after the procedure.

Generally, facet injections begin to work within 3 or 4 days although it may take as long as 7 days for the steroid to start working.

What are the results?

Most patients experience some pain relief from facet injection, on average lasting form 3-4 months. More importantly, the timing of injections should coincide with the start of physical therapy and/or home exercise program to strengthen the back muscles and prevent future pain episodes.

What are the risks?

As with any procedure, there are both potential risks and benefits. ESI is generally safe and serious complications are rare especially when using proper safety techniques such as fluoroscopy. The potential risks associated with inserting the needle include spinal headache from a dural puncture, bleeding, infection, allergic reaction, elevated blood pressure, nerve damage/paralysis (rare) and death. Corticosteroid side effects may cause weight gain, water retention, flushing (hot flashes), mood swings, insomnia, and elevated blood sugar levels in people with diabetes. Any numbness or mild muscle weakness usually resolves within 3-8 hours in the affected arm or leg (similar to the facial numbness experienced after dental work).

ESI should NOT be performed on people who have an infection, are pregnant, or have bleeding problems.

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