Facet Joint Injections
WHAT IS A FACET JOINT INJECTION?
A facet joint injection is an injection of an anti-inflammatory steroid (e.g., Dexamethasone or Triamcinolone) in the facet joints. The facet joints, also known as the zygapophysial joints, are part of the bony framework of the spine. They are small bony projections from one vertebra meeting with similar bony projections from the vertebra above or below. Sometimes, due to a variety of acute and chronic conditions, the facet joints can become inflamed. For lower back (lumbar) facet joints, the pattern of pain is usually an achiness in the low back, radiating across the lower back and slightly down the back of the buttocks and upper thighs. Usually, standing or bending backward worsens the pain. For neck (cervical) facet joints, the pattern of pain is an achiness in the neck, slight radiation across the neck and shoulders, and worsening symptoms with 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. Please allow about 45 minutes for the procedure; this will include talking to your doctor before the procedure, signing the informed consent, positioning in the room, and observation by the nurse afterwards.
WHAT MEDICINES ARE INJECTED?
The injection consists of a mixture of local anesthetic (e.g., Lidocaine) and the steroid medication (e.g., Triamcinolone).
WILL IT HURT?
All our procedures begin by injecting a small amount of local anesthetic through a very small needle. It feels like a little pinch and then a slight burning as the local anesthetic starts numbing the skin. After the skin is numb, the procedure needle feels like a bit of pressure at the injection site. If you experience any pain during the procedure, your doctor will inject more local anesthetic as needed.
WILL I “BE ASLEEP” FOR THIS PROCEDURE?
No, the procedure is done under local anesthetic only.
HOW IS IT DONE?
It is typically done with you lying on your stomach. In addition to your doctor, there will be a nurse in the room. The injection site is sterilized with either iodine or chlorhexidine. The site to be injected is numbed with a local anesthetic, and a needle is directed to the target area. X-ray guidance is used to ensure proper placement and positioning of the needle. Once proper needle placement is confirmed, the steroid solution is slowly injected.
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 because 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.
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 2-7 days and its effect can last for some time.
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.
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), rarely inadvertent puncture of the “sack” 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 temporary weight gain, temporary increase in blood sugar (mainly in diabetics), temporary water retention; you can discuss the steroid medication more completely when you come in for your injection. Some people experience flushing, sweating and/or palpitations for a few days.