FACET  JOINT  INJECTIONS

Facet joints link the bones of the spine together in the posterior or back part of the spine.  Two facet joints are present at each spinal segment.  They are named for the spinal bones that they connect.  For example, in the neck or cervical spine the facet joints between cervical #5 and cervical #6 are called C56.  Likewise, in the lower back the facet joints between lumbar #5 and the sacrum are called L5 S1.  Because there are two joints per level, there is a right and left joint.

What is the function of the facet joints?

The facet joints are important in restricting the motion of the cervical and lumbar spine. They allowed twisting, flexion and extension motions.

Why do facet joints cause pain?

Facet joints are possible sources of neck pain and lower back pain.  The facet joint is innervated by a small nerve that branches out from a spinal nerve.

Facet joints have been demonstrated to cause pain in studies in which healthy volunteers were subjected to injections of normal saline into the joint.

Trauma, arthritic changes can cause the release of pain generating substances which sensitize nerve endings located in the joint.

What are some of the signs and symptoms of facet joint pain?

For patients with facet joint pain from the lower back, complaints usually consist of pain or tenderness in the lower back slightly over to one or both sides, pain with lower back extension, pain with twisting, radiation of pain to the buttocks or back of the thighs.

For patients with facet joint pain from the neck, complaints are typically based on segment or  level involved.  Depending on the level involved, patients may have neck pain, headaches, shoulder pain, or scapular pain.

Does an x-ray or other test determined whether or not a facet joint is causing pain?

X-rays do not determine whether a facet joint is causing pain. However, x-rays may point out abnormalities such as osteoarthritis that may be significant in causing pain. A series of diagnostic blocks with local anesthetic are the only way to reliably determine whether in fact the facet joints are a source of pain.

What is a facet joint block?

A facet joint block involves the injection of a substance into or next to the facet joint. Typically, in a diagnostic block, local anesthetic is used.  In most cases a corticosteroid is also injected. Radiographic control is mandatory in accurately and safely placing the needle. The purpose of facet joint blocks is twofold.  Initially, it is a diagnostic block.  If the patient receives 50% or greater pain relief for at least 2 hours, there is an increased likelihood that the facet joint is important in the patients pain syndrome.  The block is then repeated to confirm the diagnosis. The second purpose of the facet block is to reduce pain.  Corticosteroids can help reduce the pain secondary to inflammatory substances that sensitize nerve endings.

Are facet joint blocks safe?

Yes.  The risks of facet joint blocks are very low with the use of x-ray control.  Patients may experience some small amount of injection site tenderness.  This will use the result in several days.  Risks such as headache, infection, or bleeding are extremely rare.

Do the injections hurt?

Patients undergoing facet joint injections all receive local anesthetic to anesthetize the skin and deeper tissues.  The patients may elect to receive intravenous sedation consisting of a sedative and/or a narcotic medication.

How long does it take for the injections to work?

Typically, the local anesthetic will work within 10 minutes and last up to two hours.  The corticosteroid usually takes longer for pain reduction.  It usually takes anywhere from 1 – 5 days for pain relief to occur if the pain is coming from the joint.

When can I resume normal activities following the block?

Most patients can resume normal activity the next day.  In some cases, patients may require an additional day.

What if I don’t get any relief from the facet joint injections?

If you don’t get relief from the facet joint injections, it is unlikely that this is a source of your pain.  You should then consider with your physician the other possible sources of your pain.  This may include other diagnostic blocks or imaging studies.

This procedure takes 15-30 minutes per level. You will be asked to lie in a prone position (face down) on a table in the fluoroscopy suite. Your back will be cleansed with an antiseptic (usually iodine) solution and the area will be numbed. The radiologist will use fluoroscopy (x-ray) to guide the placement of a thin needle to the area of a group of nerves that cause pain of facet syndrome. After correct needle placement is confirmed by x-rays, a small amount of local anesthetic and steroid will be injected.

Due to the effects of certain medications, your driving reflexes may be impaired. You will need someone to drive you home after the procedure. Please make the necessary arrangements.

PLEASE NOTIFY A TECHNOLOGIST IF THERE IS A CHANCE THAT YOU MAY BE PREGNANT !

FREQUENTLY ASKED QUESTIONS

Q. Why is a facet block performed?
A. A facet block may be done if you have facet syndrome. Facet syndrome may manifest itself by focal tenderness over the facet joint, or by chronic back pain that may or may not radiate elsewhere. Often, patients with facet syndrome or facet arthritis may have normal radiographs (x-rays, CT scan, and MRI). Your doctor may need to diagnose facet syndrome by performing this block.

Q. Are there any special preparations / restrictions?
A. Ideally, blood thinners should be stopped 48-72 hours prior to the procedure and any pain medications should be stopped 8 hours prior to the test. You should not have anything to eat or drink 6 hours prior to the procedure unless otherwise instructed by your physician. You will not be able to drive home after your procedure.

Q. How will I feel after the procedure?
A. You may experience numbness and/or relief from your symptoms for up to 6 hours after the injection. Your usual symptoms may then return and may possibly be worse than usual for a day or two.

Q. When will the pain relief medication take effect?
A. It may take 3-7 days before you will be able to feel any effects from the medication. If there is no change in your symptoms after 2 weeks, your doctor may want to investigate other possible sources of your pain.

Q. Are there any side effects?
A. Possible side effects of the steroid medications include headaches, mild fluid retention, increased blood sugar levels, hiccups, flushing, palpitations, difficulty sleeping. These side effects occur in only about 5% of patients and commonly disappear within 1-3 days after the injection.

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