Facet Joint Injections

Facet Joint Injections

Facet joints are small joints located at each segment of the spine. Each segment of the spine contains a three-part system consisting of two facet joints and a large intervertebral disc; together these joints and disc help to keep the body stable, move in every direction, and bear weight. Pain originating from any one of the facet joints or intervertebral disc is called facet syndrome and can be felt anywhere along the three main areas of the spine:  the lumbar, the thoracic, or the cervical regions.

The facet joints can become painful due to arthritis of the spine, a back injury, or mechanical stress to the back.

Spinal arthritis is also a painful joint issue that occurs when the cartilage protecting the vertebrae wears down and causes incredible discomfort. Typically occurring in the low back, spinal arthritis can cause bone spurs and result in pinched nerves that can radiate down the arms and legs.

What are Facet Joint Injections?

A cervical, thoracic or lumbar facet joint injection involves injecting a small amount of local anesthetic (numbing agent) and/or steroid medication, which can anesthetize the facet joints and block the pain. The pain relief provided by a facet joint injection is intended to help a patient better tolerate a treatment during physical therapy and assist with rehabilitating his or her injury or back condition.
Facet joint injections usually have two goals: to help diagnose the cause and location of pain and also to provide pain relief

  • Diagnostic goals: Injecting numbing medicine into the facet joint provides immediate relief from the pain and discomfort associated with the condition.  Assessing the amount of pain relief experienced by the patient also assists in determining if, in fact, the facet joint is the actual source of the discomfort and painful condition

  • Pain relief goals: Along with the anaesthesia, a facet joint injection also includes a time-release steroid (cortisone) with the intent of reducing inflammation and providing long-term relief of pain and associated discomfort.

Facet joint injections offer both short- and long-term relief, and when done in conjunction with radiofrequency neurotomy (RF), can also provide longer-lasting relief of severe pain and discomfort associated with back pain.

What is the Process for a Typical Facet Joint Injection?

Facet joint injections are typically performed on an outpatient basis, with the procedure taking anywhere from 20 to 30 minutes; if adding radiofrequency neurotomy, the procedure can take up to an hour.
Many people experience pain relief after just only one or two facet joint injections; the maximum number of injections a person can receive is three within a six-month time period. RF, on the other hand, requires one treatment and can be repeated every year or two.
 After receiving the injection, and shortly after the short-term anaesthesia wears off, there may be a slight, temporary increase in pain.  However, once the cortisone begins to work, patients will notice significant pain relief almost immediately

Risk Factors Associated with Facet Joint Injections

While rare, there are some general risks and a slight chance of complications associated with facet joint injections, these risks include:

  • Allergic reaction, most often the allergy is related to the contrasting dye used during imaging or an allergic reaction to the steroid; rarely is the local anesthetic the source of the allergy.

  • Infection; on rare occastion, minor infections tend to occur in less than 2% of all facet joint injections. Severe infections are even less likely, occurring in 0.1% to 0.01% of fact joint injections.

  • Nerve or spinal cord damage; while extremely rare, damage to the spinal cord or nerves can occur from direct trauma from the needle or from an infection.

In addition to risks from the injection, some patients will experience mild side effects from the steroid medication, including:

  • Steroid flushing or hot flashes for several days,
  • Retaining fluids,
  • Weight gain,
  • Increased blood pressure,
  • Mood swings.

Patients currently using certain medication, including blood thinners, or those who have an active illness, allergies, or infection should discuss this procedure with their treating physician before receiving this treatment.

Dr.Raju Mantena
Dr. Raju Mantena is an anesthesiologist and pain specialist based in the Houston area and has over 15 years of medical experience which he relies upon each day to successfully treat his patients’ acute and chronic pain.

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