Jose G. Veliz, M.D. M.S.A.
Medical Director
Palomar Pain Management Center
Pomerado Pain Management Center

Posted March 13, 2009 10:30 AM

Introduction:

Facet joints are small joints which occur in pairs on the back or side of your neck, mid back and low back.  Facet joints guide motion and provide stability to the spine.  Facet joints can cause pain due to the following reasons:

• Back injury
• Arthritis of the spine
• Mechanical stress

Facet joint injections involve injecting a local anesthetic and/or steroid medication.

Facet joint injections are performed to determine the cause and location of pain as well as to decrease pain.  When the only goal is to determine the cause and location of the pain, a numbing medicine is injected into the joint.  When longer term pain relief is sought, cortisone, along with the numbing medicine, is injected into the facet joints in order to decrease inflammation. 

Anatomy:

The spine consists of the cervical (neck), thoracic (mid back) and lumbar (low back) regions.  Each spinal segment consists of a pair of facet joints which are located between the vertebra.  In the lumbar and thoracic spine, the facet joints are located on the back of the spinal column.  In the cervical spine, the facet joints are located on each side of the vertebra. 

The facet joints allow you to bend forward and backward.  They also allow you to twist.  The surfaces of the facet joints are covered by articulate cartilage.  There is also a surrounding capsule which is filled with synovial fluid.  The cartilage acts as a cushion which reduces the friction between the opposing bones. 

The facet joints produce typical pain patterns depending on their location.  Pain emanating from cervical facet joints can radiate to the head, neck, shoulder and/or arm.  Pain emanating from the thoracic facet joints can be felt in the mid back, chest and/or arm.  Pain emanating from the lumbar facet joints can result in the pain being felt in the lower back, buttock, hip and/or leg. 

Goal of the Procedure:

You doctor is performing a facet joint injection in order to determine whether or not the facet joints are the cause of your neck pain, mid back pain or low back pain.  If, in addition to local anesthetic, cortisone is injected, longer term pain relief may occur.  If it is determined that the facet joint is causing your pain, other procedures may be performed for prolonged pain relief.  An example is facet joint radiofrequency also known as facet joint rhizotomy.  Another goal of facet joint injections is to allow you to begin a physical therapy program by decreasing your pain.  It is not uncommon for facet joint pain to be severe enough so as to not allow physical therapy to begin.

Procedure:

Prior to the procedure, the physician will perform a history to determine the following:

• Are you allergic to any of the medications being used?
• Do you have any active infections?
• Are you using any blood thinners?  

Your physician may perform the procedure with local anesthetic only or, commonly, oral sedation and IV sedation are used.  If IV sedation is used, an IV line will be placed by your doctor. 

During the procedure, you will be asked to lay face down on an x-ray table.  The skin over the area to be treated is cleaned with a sterile solution.  You may be given oxygen via a nasal cannula inserted into your nostrils. 

Using a local anesthetic, your doctor will numb the skin over the area to be treated.  This is similar to a local anesthetic being administered by your dentist prior to a procedure.  Unfortunately, this may sting or burn for a few seconds.

A small needle is inserted into the facet joint using x-ray guidance (fluoroscopy).  In order to confirm that the needle is properly placed into the joint, contrast dye may be injected as well. 

A local anesthetic such as Lidocaine, and an anti-inflammatory medication such as cortisone, is injected into the facet joint. 

The patient recovers for approximately 30 minutes and then is asked to move his or her area of usual discomfort in order to try to provoke the normal amount of pain.  Recording the relief obtained during the next week is important in order to relay this information to your doctor. 

If the facet joints injected are your main pain source, then you may obtain relief for a few hours after the injection.  There may be a slight increase in your pain for a few days after the local anesthetic wears off and before the cortisone becomes effective.  It is not uncommon for your spine to feel weak for a few hours after the injection.

For the first two to three days after the injection, apply ice for 20 minutes at a time if any discomfort is noted.  A barrier should be placed between the ice and the skin.  Improvement in the pain symptoms can occur in as long as five days after the injection. 

On the day of the procedure, it is advisable to avoid any strenuous activities.  If you were given sedation, you should not drive for 24 hours after the procedure.

Blood thinning medications should not be taken until the following day.  However, it is important to take your regular medication before and immediately after the procedure. 

Patients may return to their regular activities on the day after the procedure.  If the pain is improved, exercise and activities should be performed in moderation.  Activities should be increased gradually and not suddenly over the next one to four weeks. 

Facet joint injections may be performed up to three times per year if the initial procedure decreased pain by at least 50%. 

Complications:

Although complications are uncommon, they can occur.  They include the following:

• Allergic reaction
• Infection
• Increased pain – Increased pain is temporary unless it is the result of an infection. 
• Nerve damage

If any of these complications occur, contact your doctor immediately.