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Facet Joint Injections

What are they? How are they done?


The facet joints, are located on the back of the spine on each side of the vertebrae where it overlaps the neighbouring vertebrae. The facet joints provide stability and give the spine the ability to bend and twist. They are made up of the two surfaces of the adjacent vertebrae, which are separated by a thin layer of cartilage. The joint is surrounded by a sac-like capsule and is filled with synovial fluid (a lubricating liquid that reduces the friction between the two bone surfaces when the spine moves and also nourishes the cartilage.)


Why Get A Facet Joint Injection?


There are basically two reasons for having a facet joint injection: for diagnosis (to determine the source of pain) or for therapy (to treat an abnormality that has been detected.)


For diagnosis: To determine if a facet joint is truly the source of back pain, an injection (sometimes called a “block”) may be prescribed. If an injection of a small amount of anaesthetic into the facet joint reduces or removes the pain, then it is likely that the facet joint is the source of the pain.


Once a facet joint is pinpointed as a source of pain, therapeutic injections of anaesthetic and anti inflammatory medications may give pain relief for longer periods of time.


How Are The Injections Performed?


Facet joint injections are performed while you are awake, under a local anaesthetic, and able to communicate. The injection is usually performed while you are lying on an X-ray table. During the procedure, you probably will undergo a fluoroscopic X-ray that allows your health care provider to place the syringe in the correct facet joint. The doctor will clean and sterilise the area of the back directly over the affected joint and will then use a local anaesthetic to numb the skin over the injection site. Once the proper site has been determined, your health care provider will inject the anaesthetic and the anti-inflammatory (usually a corticosteroid.) You may be asked whether you are experiencing pain relief or not, to make sure the injection is in the right place and determine if additional injections are needed. This process may then be repeated depending on the number of affected facet joints. Although the actual injection takes only a few minutes, the overall procedure usually takes approximately 30 to 60 minutes.

Are There Special Preparations?


If you are to undergo a facet joint injection, you should not take any nonsteroidal anti-inflammatory (NSAID) medications for 24 hours prior to the procedure. You should also not take any prescription pain relievers for at least four hours before the injection..


What Happens After The Injection?


Immediately following the procedure, you may feel a reduction or complete relief of your back pain. You  may be asked to perform a task that would normally cause pain to assess the level of pain relief. You will be able to walk immediately after the procedure, although some patients may experience leg weakness, numbness or tingling for a few hours after the injection. Because your reaction times may be affected by the medications, driving is not recommended immediately following the injection. You probably should have someone who is able to drive you home following the procedure.

Once home, you can treat any pain you may have at the injection site with ice or a pain medication. It is generally recommended that you take it easy and not exert yourself for the first day. After the anaesthetic component of the injection wears off, your back pain may return. It may take seven to ten days for the steroid component of the injection to relieve the pain. After the first day, you can usually return to your daily activities as your pain will allow; however, you should generally rest for 2 weeks from higher intensity activities and sport.


How Effective Are Facet Joint Injections?


The effectiveness of facet joint injections for the treatment of low back pain is controversial. It is vital to recognise that such injections can give relief in appropriate patients but do not replace the need for proper exercise therapy to strengthen the back and take the load away from the affected joints. It has been recommended that facet joint injections be used as a method to allow the patient to be able to perform other forms of conservative treatment (such as physical exercise, yoga and stretching and bending), rather than using it as a stand-alone pain treatment.


Are There Side Effects?


There is a possibility of side effects with just about any medical procedure. Possible side effects from facet joint injections include pain at the injection site, bleeding, infection or a worsening of the pain symptoms.