Facet Joint Injections
Facet joints are the small joints lining each vertebrae. Facet joint injections help to reduce pain immediately and the effects are usually extremely long-lasting.
Who performs the procedure?
Physicians who administer joint injections include physiatrists, radiologists, anesthesiologists, neurologists, and surgeons.
What happens before treatment?
The doctor who will perform the procedure reviews your medical history and previous imaging studies to plan the best location for the injections. Patients who take aspirin or a blood thinning medication may need to stop taking it several days before the procedure. The procedure is usually performed in an outpatient special procedure suite that has access to fluoroscopy. Patients should make arrangements to have someone drive them to and from the office the day of the injection.
What happens during treatment?
At the time of the procedure, the patient will be asked to sign consent forms, list medications they are presently taking, and if they have any allergies to medication. The procedure may last 15-45 minutes, followed by a recovery period.
Step 1: prepare the patient
The patient lies down on the table. Local anesthetic is used to numb the treatment area so discomfort is minimal throughout the procedure. The patient remains awake and aware during the procedure to provide feedback to the physician. A low dose sedative, such as Valium or Versed, is usually the only medication given for this procedure.
Step 2: insert the needle
With the aid of a fluoroscope, the doctor directs a hollow needle through the skin and into the region responsible for pain. Fluoroscopy allows the doctor to watch the needle in real-time on the fluoroscope monitor to ensure that the needle goes to the desired location . Contrast may be injected to confirm correct needle location. Some discomfort occurs, but patients more commonly feel pressure than pain.
Step 3: inject the medication
When the needle is correctly positioned, the anesthetic and corticosteroid medications are injected into the joint capsule. The needle is then removed. One or several joints may be injected depending on the location of the pain.
What are the results?
If the joint that was treated is the source of pain, you may notice pain relief starting two to seven days after the injection. Pain may be relieved for several days to several months, allowing you to participate in physical therapy. If injections were helpful and you experience a later recurrence of pain, the procedure can be repeated. If you don’t experience any pain relief, other treatment options may be available.
What are the risks?
With few risks, steroid joint injections are considered an appropriate nonsurgical treatment for some patients. The potential risks associated with inserting the needle include bleeding, infection, allergic reaction, headache, and nerve damage (rare). Corticosteroid side effects may cause temporary weight gain, water retention, flushing (hot flashes), mood swings or insomnia, and elevated blood sugar levels in diabetics. These effects usually disappear within 7-10 days. Patients who are being treated for chronic conditions (e.g. heart disease, diabetes, rheumatoid arthritis, glaucoma, uncontrolled blood pressure) or those who cannot temporarily discontinue anti-clotting medication should consult their personal physician for a risk assessment.