Facet joint injection

A facet joint injections are recommended if you suffer from severe pain on areas of the spine as a result of degenerative conditions, like facet joint arthritis. It is a minimally invasive technique that involves injecting a tiny amount of local anaesthetic and sometimes steroids into or around a facet joint to reduce inflammation, and give long-term pain relief. The local anaesthetics numb the nerves that supply pain relief to the facet joint. Steroids suppress inflammation and may extend the duration of pain alleviation.

Facet joint injections can also be used as a diagnostic tool to determine whether pain is caused by your facet joints.

What is a facet joint?

The facet joints are the joints that connect the spine's bones, called vertebrae. Each vertebra has four facet joints, one pair for the vertebra above (superior facets) and one pair for the vertebra below (inferior facets). The nerve roots that run from the spinal cord to the arms, legs, and other portions of the body pass through these joints. These joints also allow the spine to bend and twist, as well as providing support and stability in the spine.

What causes facet joint pain?

Facet joint pain can be comparable to disc pain in nature. It can be caused by an injury, repetitive movements, obesity, poor posture, and other spinal disorders such as arthritis or degeneration, that alter the alignment and movement of the facet joints. The degeneration of a spinal disc can lead to changes in the facet joints.

What is facet arthritis?

Facet arthritis is caused by the wear and tear of the cartilage that covers the ends of the facet joints. This can lead to the formation of osteophytes, known as bone spurs, which are bony projections that develop along bone edges causing enlargement of the facet joint. Pain and stiffness are common symptoms of facet arthritis.

It's important to remember that while facet joint injections can help with symptoms, they don't change the underlying cause of spine degeneration.

Who is an ideal candidate for facet joint injections?

You may be an ideal candidate for a facet joint injection if you have:

  • Spinal stenosis, causing back and leg pain, especially when walking.
  • Spondylolisthesis, where degenerative conditions in the spine causes slippage of one vertebra onto the next.
  • Sciatica, where pain runs down the buttocks and legs along the sciatic nerve.
  • Herniated disk caused by a the gel-like centre of a disk bursts through a weak spot in the thick outer wall resulting in irritation, pain and swelling when it comes into contact with a spinal nerve.
  • Arthritis which is inflammation of the joints caused by cartilage deterioration producing pain, swelling, redness, and restricted movement.
  • Postoperative pain caused by a disturbance of the facet joint or spine muscles following a discectomy or spinal decompression.
  • More conservative treatment for facet joint pain has not been effective.
  • The injection could be used as a diagnostic test to see if the facet joint is the source of your pain. Inflammation of the facet joints can be treated by facet injections.

What are the conservative treatments for facet joint pain?

Conservative treatments such as anti-inflammatory drugs, rest, back braces, or physical therapymay reduce or eliminate pain.

If poor posture is the cause of facet joint pain, this can be addressed with treatments like physiotherapy.

What happens during a facet joint injection procedure?

A facet joint injection is normally done under local anaesthetic and takes less than 30 minutes. A small drip (called a cannula) may be implanted in the back of your hand so that a sedative can be administered intravenously should you need it. Because the needle is so small, you may not feel anything while it is implanted. Fluids can be supplied from an IV bag through a small gap on the cannula.

You will be helped to lie on your front. The injection site will be cleaned with an antiseptic, then a local anaesthetic will be injected. Your Consultant will carefully insert the needle for your injection after you confirm the area is numb. A dye and an x-ray are used to make sure the needle is in the correct locations. An ultrasound scanner is sometimes used to guide the needle. If you experience any discomfort during the process, you should let your Consultant know. You may feel temporary pain or an electric shock down your leg, but this is normally very brief.

To prevent bleeding, pressure will be applied and the skin opening will be covered with a bandage.

After the procedure your IV line will be removed if you were sedated and you will be transferred to an observation area for 20-30minutes while you recover.

The area where the needle was inserted may be uncomfortable for a few days. You can apply ice or a cold pack to the injection site to relieve any pain, and you will be prescribed pain medication. For the next 24 hours, avoid intense activities and driving.

You may experience an increase in pain as the pain medication wears off, before the steroids begin to take effect.

Frequently Asked Questions

Facet joint injections FAQs

Our Consultant Orthopaedic Surgeon are back and spine specialists hava all the answers to all the frequently asked questions about facet joint injections.

You should not expect to be under sedation during a facet joint injection. However, you could be given medication to relax you if you need it.

Avoid strenuous activities. To ensure that the diagnostic information acquired is correct, patients should minimise pain medication for the first four to six hours after the injection. Unless your Consultant says otherwise, avoid driving.

  • If you have any of the following, you may not be a candidate:
  • If you have an infection
  • If you are pregnant
  • If you have bleeding problems
  • If you have high blood pressure
  • If you have diabetes as it my temporarily raise blood sugar levels, but usually for less than 24 hours

Facet joint injections are a safe and effective treatment for neck and back pain caused by degenerative conditions like arthritis.

As the local anaesthetic begins to numb the skin, it feels like a tiny pinch followed by a slight burning. The treatment needle feels like a touch of pressure at the injection site after the skin has been numbed. Your surgeon will inject extra local anaesthetic as needed if you suffer any pain throughout the treatment.

A nerve block is when a local anaesthetic or steroid, or a mixture of both, are injected into one facet joint. A facet joint injection, on the other hand, can be done on one or more facet joints, and on one or both sides of the spine.

Both treatments are used to relieve pain, but they treat distinct underlying conditions. Back pain that radiates to the arm or legs is treated with epidural injections. Facet injections, on the other hand, are administered into the facet joints of individuals with degenerative diseases.

If the facet joint injection procedure is successful in relieving pain, it is normal practice to repeat the procedure up to three times each year. The injection should not be repeated if the first facet joint injection does not relieve pain.

Injections can sometimes cause more pain. This could be related to an increase in muscular tightness surrounding the injection site. The increased pain is usually temporary, lasting a few hours or days.

A joint injection's steroid does not start functioning right away. It usually takes two to seven days to notice a reduction in pain. However, as facet joint injections also comprise of a local anaesthetic, there will be some alleviation of pain right after the injection.

  • If you have facet joint syndrome
  • Tenderness over the facet joints
  • Low back pain
  • Post-laminectomy syndrome with no evidence of arachnoiditis or recurrent disc disease
  • Persistent low back pain after spinal fusion

  • Allergic reaction X-ray contrast or steroids are common but local anaesthetic allergies are rare. However, these kinds of allergies are rarely life threatening.
  • Bleeding is an uncommon consequence that occurs more frequently in patients with underlying bleeding disorders or those taking blood thinners.
  • Infection. In less than 1% to 2% of all injections, minor infections occur. Severe infections are uncommon, occurring in 0.1% to 0.1% of all injections.
  • Discomfort at the injection site or an increase in pain symptoms. These signs and symptoms are usually modest and temporary. Long-term increases in pain are uncommon.
  • Damage to the nerves or paralysis of the spinal cord nerves can be caused directly by the needle, or indirectly by infection, haemorrhage causing compression, or injection into an artery that causes obstruction.
  • Side effects from the steroid medication, such as: increased hunger, fluid retention, weight gain, hot flushes that last for several days, mood swings, temporary decrease in immunity and insomnia.

Facet joint injections should be carried out by an orthopaedic surgeon who specialises in back and spine surgery alone. An orthopaedic surgeon is medically qualified, surgically trained and further qualified.

Facet joint injections should only be performed by fellowship trained orthopaedic surgeons with good fellowship exposure as advised by NICE.

At Schoen Clinic London we understand how important your time is, so we champion rapid recovery.

It could take up to two weeks in some cases. You should expect pain relief for several months if your facet joint injection is successful. Remember that each patient will react differently. You may get complete pain relief, partial pain relief, or none at all.

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