FAQs on Facet Joint Injections
A facet joint injection is the instillation of medication into the actual facet joint. A facet joint is located between each set of vertebrae in the spine from the top of the neck to the end of the coccyx (tailbone). The facet joint allows each vertebra to move against the one above and below it. These injections are used to reduce swelling of the tissue and inflammation around the facet joint space. Once the inflammation and swelling subsides, the pain is also reduced. Facet joint pain can cause pain in the back, legs, arms, and buttocks.
Patients who are candidates for a facet joint injection include those who have chronic neck and back pain, people with severe whiplash injuries, chronic back disorders and conditions, and persistent aggravating symptoms. Also, anti-inflammatory medication, physical therapy, and chiropractic care does not work for these patients.
The actual facet joint injection procedure only takes around 10 to 20 minutes. The doctor will insert a needle through the skin and tissues, and there is some pain involved with this. The doctor will start an intravenous line to give you medication and sedatives if necessary. This procedure is done under local anesthesia, which means the area is anesthetized.
Some patients receive enough medication so that they do not remember the procedure. The facet injection is done under x-ray guidance, and the doctor will monitor the heart rate, blood pressure, and oxygen using monitoring devices. Usually, only one side of the spine is done at the visit, and no more than three or four joints are injected at one time.
After the Procedure
Immediately after the facet joint injection, the patient will not feel pain or the pain will be less. This means the back and neck will be sore for a day or two. After this, the site will be slightly irritated and inflamed. All patients require a ride home, and cannot do heavy lifting for a couple of days. The doctor will advise you to use ice on the injection site to ease the pain. Unless there are side effects or complications, you will not return to work the next day.
After the procedure, the effects of the steroid medication are seen in three to five days, and this can last for up to a few months. However, some people only enjoy relief of pain for a few days. Most patients only need one facet injection per joint, but these are often used as diagnostic injections to confirm a condition. After a confirmation of a condition is made, the doctor may do a facet rhizotomy where a small nerve branchy is electrically burned to decrease the painful sensation in the facet joint for a long period of time. This take several visits, and the patient may choose to have a repeat injection rather than the rhizotomy.
The facet injection is used to relieve long standing pain, which occurs from arthritis or inflammation from a spinal disorder. The risks of this procedure are similar to those of a spinal epidural block. These include infection, bleeding, weight gain, elevated blood sugar, water retention, suppression of the body’s defense, and elevated blood sugar. If a patient is allergic to lidocaine or steroid medication, he/she should not get a facet joint injection. Also, a person who is on blood thinners should not have this procedure.
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Carette S, Marcoux S, Truchon R, et al. A controlled trial of corticosteroid injections into facet joints for chronic low back pain. N Engl J Med. Oct 3 1991;325(14):1002-7.
Murtagh R. The art and science of nerve root and facet blocks. Neuroimaging Clin N Am. Aug 2000;10(3):465-77.
Zennaro H, Dousset V, Viaud B, et al. Periganglionic foraminal steroid injections performed under CT control. AJNR Am J Neuroradiol. Feb 1998;19(2):349-52.