A facet joint is the joint between the inferior articular process of a vertebrae and the superior articular process of the next descending vertebrae. This joint provides stability to the spine and allows for the wide range of motion that is possible with the spine. If this joint did not exist the spine would not be rigid and able to support the body, yet if this joint were fused the spine would have no mobility.
Often, due to age related conditions such as arthritis or due to injury, these joints become inflamed and so the multitude of nerves in the area of the joint produce and send pain signals to the brain. This pain is often excruciating and debilitating to the point that the patient does not respond adequately to oral pain medications. In these cases the patient will likely benefit from facet injections (facet joint injections).
What are facet joint injections?
Facet joint injections are injections of numbing medications into the facet joints which are intended to numb the nerves in the area of the joint and so stop pain signals to the brain.
What conditions are treatable with facet joint injections?
Facet joint injections can be used diagnostically to confirm the location of the suspected affected area; these injections typically consist only of local anesthetic drugs to numb the nerve temporarily. If relief is achieved then it is a correct diagnosis and further injections will consist of a mixture of local anesthetic and corticosteroid medications to provide longer lasting relief. Facet joint injections are intended to relieve pain specific to the facet joints of any area of the spine regardless of the cause of the pain, which can be from arthritis or trauma.
Patients unable to perform physical therapy due to facet joint pain can benefit from facet injections. The facet injections will help them tolerate the physical activity better and enable them to perform the exercises prescribed.
What are expectations when a patient receives facet joint injections?
Facet joint injections have been used for several years so it could reasonably be said that the procedure has been performed millions of times and that the majority of these procedures have been effective in reducing or eliminating the patients pain. The majority of patients receiving facet joint injections report a significant decrease in felt pain levels, some report complete freedom from pain.
How are facet joint injections performed?
Typically the doctor will use the injections diagnostically the first time and inject only local anesthetic. If this proves successful in relieving pain the subsequent procedures will consist of a mixture of local anesthetic and corticosteroid in order to provide prolonged relief.
The procedure can be performed with the patient sedated although is usually not, and the doctor may treat several locations in one sitting. The patient is placed on an exam table and may have their vital signs monitored, the area(s) to be injected are cleaned with antiseptic solution and numbed with topical anesthetic.
A thin needle is then inserted using a device called a fluoroscope (a type of xray machine that allows the doctor to see the needle being inserted in real time) to ensure proper needle placement. A contrast dye is usually injected to confirm the needle placement and that the medications will contact the desired nerves, the numbing medications are then slowly injected. The procedure takes between fifteen and thirty minutes, depending on the number of injections.
After the procedure has been completed the patient will remain for a period of thirty minutes for observation for negative reactions to the medications, although rare, it can happen.
How long do the effects of facet joint injections last?
The local anesthetic used usually provides immediate relief; this is temporary and usually wears off in twenty four hours. The steroid medications may take up to forty eight hours to begin having an effect but then may provide continued relief for days or even weeks. After subsequent injections patients often report being pain free for months at a time.
What risk or side effects are possible with facet joint injections?
As with any medical procedure there are some risks although small. These include slight bruising, swelling, and bleeding at the injection site. Infection may occur if the injection site is not kept clean until it heals. There is some small risk of nerve damage but this is generally negated when the fluoroscope is used. Repeated injections of steroid medications into the same area can cause soft tissue degeneration, but this is very rare.
How successful are facet joint injections for the relief of pain?
Better than 75% of patients receiving facet joint injections report a significant decrease in felt pain levels, some report being pain free.
What is the bottom line on facet injections?
If you experience chronic pain caused by a facet joint and the pain is not responsive to oral medications discuss with your doctor to determine if you could benefit from facet injections.