What is a facet joint injection?
A facet joint injection is an injection of an anti-inflammatory steroid medication into the facet joints. The facet joints are small joints on each side of the spine which help support some of the weight of spine and help with movement. Sometimes, due to a variety of acute and chronic conditions, the facet joints can become inflamed and cause aching in the low back, with radiation sometimes down the back of the buttocks and thighs. Usually, standing or bending backward worsens the pain. For neck (cervical) facet joints, the pattern of pain is achiness in the neck muscles, with sometimes headaches or radiation of pain across the neck and shoulders, and worsening pain symptoms certain neck movements like turning the head from side to side or looking up.
How long does it take to do?
The actual injection takes only a few minutes. However, please allow about an hour for the procedure; this will include talking to your doctor before the procedure if you have questions, sometimes insertion of an iv, signing the informed consent, positioning in the room, and observation by the recovery room nurse afterwards.
What medicines are injected?
The injection consists of a mixture of local anesthetic (e.g., bupivacaine or lidocaine) and a small amount of a steroid medication (usually methylprednisolone).
Will it hurt?
All procedures begin with your doctor injecting a small amount of local anesthetic through a very small needle into the skin. It feels like a little pinch and then a slight burning as the local anesthetic starts numbing the skin, which lasts for only a few seconds. After the skin is numb, the procedure needle will feel like a mild pressure sensation only at the injection site. Occasionally as the needle approaches the bone area to be injected, it may feel a little sharp briefly. If you experience any pain during the procedure, your doctor will inject more local anesthetic as needed- all you have to do is tell your doctor that you are feeling a little sharpness.
Will I be “put out” for this procedure?
No. This procedure is done under local anesthesia. If you are very anxious we can sometimes give you sedation but this does involve putting an iv line into your arm, and the facet joint injections are usually so quickly done that is not usually necessary or indicated.
How is it done?
It is usually done with you lying on your stomach for back injections and on your side or your stomach for neck injections. Your blood pressure, pulse and oxygenation will be monitored. In addition to your doctor and the x-ray technician, there will be a nurse in the room at all times if you have any questions or discomfort during the procedure. The skin in the back is cleaned with antiseptic solution and then the procedure is done. Very small needles are placed in the joint capsule and a small volume (usually about 1 cc) is injected into in each joint.
What should I expect after the injection?
Shortly after the injection, you may notice that your pain may be gone or considerably less. This is due to the effect of the local anesthetic and lasts only for a few hours. Your pain may return and you may have some soreness at the injection site for a day or so. You should start noticing pain relief starting about 1-2 days after the procedure.
What should I do after the procedure?
We advise the patients to take it easy for a day or so after the procedure. Perform the activities as tolerated by you. Your recovery room nurse will advise you about applying ice to the site or heat, whichever feels better.
Can I go back to work the same day or the next day?
You should be able to unless the procedure was complicated which is very unusual. Your doctor or recovery room nurse will discuss this with you.
How long does it last?
The long-term effect of the medication cannot be predicted. Usually, the immediate effect is from the local anesthetic injected. This wears off in a few hours. The steroid starts working in about 1-2 days and its effect can last for several days to a few months. Pain relief can vary from 50% to 100% – if less than this, perhaps the majority of your pain is coming from a different source e.g muscles, discs or nerves.
How many injections do I need to have?
This will vary with each patient; your doctor will discuss this with you.
Can I have more than one injection?
If the first injection is successful but the pain returns, you may be eligible for another injection, if you had relief from pain for a reasonable period of time. Your doctor will discuss this with you.
How will I know if it will help?
It is very difficult to predict how helpful injections will be. Generally, patients who have the symptoms described above will do well. Obviously, since there are several pain generators in the spine, the degree of response will vary widely. Patients with recent onset of pain may respond much better than ones with longstanding pain.
What are the risks and side effects?
Overall, this procedure has very few risks. However, as with any procedure, there are some risks and side effects you should know about. Commonly encountered side effects are increased pain from the injection (usually temporary), inadvertent puncture of the “sac” containing spinal fluid (may cause headaches), infection, bleeding, nerve damage, or no relief from your usual pain. Side effects of the injected steroid may include weight gain, increase in blood sugar (mainly in diabetics, temporary), water retention, suppression of your own natural production of steroids, or temporary suppression of your immune system – all these effects usually only occur if you have > 3-4 of these type of injections a year.
Who should not have this injection?
The following patients should not have this injection: if you are allergic to any of the medications to be injected, if you are on a blood-thinning medication (e.g. coumadin with an INR > 2 , injectable heparin), or if you have an active infection going on.