Facet Joint Injections For Back Pain
Facet joint injections, also known as facet block injections, serve two main purposes. The first is to diagnose facet joint pain, and the second is to treat this kind of back pain. The procedure can be done quickly and easily, right here in the office, and it can enable you to give your doctor instant feedback so that an accurate diagnosis can be made.
What are facet joints?
Facet joints are the small joints located on either side of your vertebrae, in the back of the spine. They help to stabilize the spine and facilitate small twisting and bending movements.
The joints themselves are coated in cartilage, and the entire joint is surrounded by a fluid-filled capsule. The cartilage and the synovial fluid together lubricate the joint and reduce friction during movement.
Cervical facet joints are in the back or side of the neck. Thoracic facet joints are in the upper back and lumbar facet joints are in the lower back.
Facet Joint Pain
Many conditions can damage these joints. When the cartilage is damaged by injury or disease, this causes the bony tissue of the joints to rub together, causing chronic back or neck pain.
Depending on which affected joints, pain can be located in different areas of the body:
Cervical facet joints (neck). Pain is usually felt in the head, neck, shoulder, and/or arm.
Thoracic facet joints (upper back). Pain is typically felt in the upper back, chest, and/or arm (rare).
Lumbar facet joints (lower spine/back). Pain is typically felt in the lower back, hip, buttock, and/or leg.
A facet joint injection can treat pain caused by:
Pain of cervical facet joint
Bulging of cervical intervertebral disc
Lumbar degenerative disc disease
Low back pain
Lumbar foraminal stenosis
Bulging of the lumbar intervertebral disc
How Does a Facet Joint Injection Work?
Facet Joint Injections, Advanced Pain Management Los AngelesThe facet injection is performed in the office as an outpatient procedure. First, the doctor identifies which facet joint may be causing the problem. Then, two facet injections will be administered. This is usually done under X-ray guidance using a procedure called fluoroscopy.
For most facet joint injections, the procedure is done with the patient lying on the stomach. Some cervical or neck area facet injections are done in other positions. All facet injections are done under x-ray guidance. EKG, blood pressure cuff and blood oxygen-monitoring devices are utilized when a patient receives intravenous sedation. Typically, only one side of the neck or back is done at any visit. No more than three or perhaps four joints are injected at any visit.
The first injection is simply a local anesthetic (numbing medicine), which will be delivered into the skin right above the target joint. The next injection will contain high-contrast dye, more local anesthetic, and a corticosteroid, anti-inflammatory medication. This injection will be inserted into the facet joint itself.
The high-contrast dye helps the physician to confirm that needle placement is correct.
The local anesthetic will provide rapid pain relief, so that you can tell the doctor if that joint was indeed the source of pain.
The corticosteroid acts as an anti-inflammatory medication to provide long-lasting pain relief.
The whole procedure takes 20-30 minutes, and you can go home right after your appointment. You may receive additional injections, but typically doctors recommend three or fewer within a 6-month timeframe.
Facet Joint Injection Side Effects
You may feel some discomfort from the injections, but typically the local anesthetic near the injection site will keep you comfortable during the procedure.
Side effects are rare, but some commonly-reported effects of steroids include:
Changes in appetite
In the first day or two after your injections, you may experience some soreness near the injection site. Some local tenderness may be experienced for a couple of days after the facet injection. Using an ice pack three or four times a day may help alleviate this. This is a common result of the anesthetic wearing off before the anti-inflammatory effects have kicked in. You should go easy during this period of time and expect greater pain relief on the second or third day.