Facet Joint Injection
The facet joint is a synovial joint in the spine that is similar to the knee or hip joint in that it has a joint capsule, articular cartilage, a nerve supply, and can become painful. Facet joints are paired (one on each side) and are present from the top of the cervical spine in the neck all the way down and through the lumbar spine in the lower back.
What causes Facet Joint Pain?
Common causes of facet joint pain include arthritis, degenerative disease of the spine, and trauma. In the absence of injury or accident, the most common cause for facet mediated pain is degenerative disease of the spine or arthritis. Therefore, older patients are more commonly afflicted with facet joint pain. In whiplash injuries of the neck, commonly seen in motor vehicle accidents and other traumatic events, the cervical facet joints can be traumatized, and this can lead to chronic neck pain and headaches.
What are the symptoms of Facet Syndrome?
Symptoms of painful facet joints in the lumbar spine (Lumbar Facet Syndrome) include low back pain and pain into the buttocks, hips, thighs, and groin areas. Symptoms of painful facet joints in the cervical spine (Cervical Facet Syndrome) include neck pain, upper back pain, shoulder pain, and headaches. Other conditions, especially in low back pain patients, can mimic the symptoms seen in facet syndrome and include Discogenic Pain (painful intervertebral disc), Sacroiliac Joint (SI Joint) pain, and Myofascial Pain.
How is Facet Joint Injection done?
Facet Joint Injection is a simple, safe, and effective minimally invasive treatment for spinal pain that involves the injection of a steroid medication similar to cortisone into the facet joints in the spine. X-Ray guidance (fluoroscopy) is used to identify the facet joints and to guide needle placement. The injection is performed under local anesthesia and, on occasion, with intravenous sedation. Patients are not deeply sedated or completely asleep for this procedure because it is unnecessary and unsafe to do so. Depending on the location and laterality (side) of the neck or back pain, this procedure takes approximately 10-15 minutes to perform, followed by a brief recovery before discharge home.
Does the injection hurt?
The injection of local anesthetic (numbing medicine) at the beginning of the procedure may sting some, but Facet Joint Injection is an otherwise routine procedure that is extremely well tolerated by patients ranging in age from the mid-teens to well over ninety years old. If you are anxious or concerned about pain during the procedure, please discuss with Dr. Hijazi the possibility for your receiving intravenous sedation.
What should I do to prepare for my injection?
If you are scheduled to receive sedation during the procedure, you must have someone available to drive you home. If you usually take medication for high blood pressure or any kind of heart condition, it is very important that you take this medication at the usual time with a sip of water before your procedure. If you are taking any type of medication that can thin the blood and cause excessive bleeding, you should (continued) discuss with your doctors whether to discontinue this medication prior to the procedure. These anticoagulant meds are usually prescribed to protect a patient against stroke, heart attack, or other vascular occlusion event. Therefore the decision to discontinue one of these medications is not made by the pain management physician but rather by the primary care or specialty physician (cardiologist) who prescribes and manages that medication. Examples of medications that could promote surgical bleeding include Coumadin, Plavix, Aggrenox, Pletal, Ticlid, and Lovenox.
What should I expect after the injection?
When the local anesthetic used to numb the skin wears off, you will probably experience some discomfort where the needles were placed. Although pain relief with Facet Joint Injection generally occurs within 3 - 5 days, some patients experience improvement before or after this time period. Diabetic patients should be on the alert for a rise in blood sugar during the first few days after injection and must monitor blood sugar accordingly.
What should I do after my injection?
Following discharge home, you should plan on simple rest and relaxation. If you have pain at the injection sites, application of an ice pack to the area should be helpful. If you receive intravenous sedation, you should not drive a car for at least eight hours. Patients are generally advised to go home and not return to work after this type of injection. Most people do return to work the next day.
How many injections will I need during my treatment?
In contrast to other procedures done for spinal pain (ie. Epidural Steroid Injection), Facet Joint Injection is not done in any type of series. Therefore patients are usually seen for a follow-up office visit 4-6 weeks after this procedure, and additional injection therapy is not scheduled before that time.
Could there be side effects or complications?
Minor side effects from the injected medications are not uncommon and can include nausea, itching, rash, facial flushing and sweating among other things. Some patients notice a mild increase or worsening of their pain for the first day or two after injection. Fortunately, Facet Joint Injection has an extremely good safety profile, and serious complications are quite rare. Just like any other medical procedure, there are potential complications associated with this procedure.
Can these injections be repeated if my pain returns?
If the first set of Facet Joint Injections provides you with three or more months of pain relief, they can be repeated if/when the pain returns. If you have no pain relief following this treatment or if the relief is only short-term, other treatments may be required.
Is there a treatment for Facet Syndrome that is long-lasting?
Yes. It is possible to actually destroy or “burn” the nerves that innervate painful facet joints with the Facet Joint Neurotomy/Radiofrequency Ablation procedure. This is an outpatient procedure similar to Facet Joint Injection, but instead of injecting medication to reduce facet joint inflammation, the physician places a needle next to the nerves that innervate the painful facet joints, heats the tip of the needles with radiofrequency energy, and selectively destroys these nerves. A successful outcome following Facet Joint Neurotomy/Radiofrequency Ablation can lead to pain relief that lasts for up to 18 months. Not all patients with neck or back pain are a candidate for this procedure. In fact, patients must have a positive response to a diagnostic nerve block procedure before this next step is performed.