What is a facet joint injection?
Facet joints, also known as zygapophyseal joints, are small cartilage lined joints in your spine. They connect the different levels of your vertebrae (bones of your spine) and provide stability and flexibility to your spine during movement. The medial branches are the nerves that supply the facet joints and are responsible in transmitting pain and sensory signals to your spinal cord and eventually your brain.
Due to the stress facet joints experience they can be subject to injury and disease such as arthritis. They can be the cause of up to 60% of cases of back and neck pain, but are rarely the sole cause of spinal pain.
The facet joints, and oftentimes the medial branch nerves, can be injected with local anesthetic (numbing agent) and/or steroid. These injections can serve one of two purposes:
- Diagnostic: improved pain can help determine that the facet joint is the cause of pain
- Therapeutic: treat the pain arising from the facet joint
How effective are facet joint injections?
The effectiveness of a facet joint injection does depend on the condition being treated and varies from patient to patient. It is difficult to predict your outcome before the procedure. If a facet joint injection is being used as a diagnostic tool then there may not be any relief if the facet joint is not the source of your problem.
Many patients often report immediate relief after the injection due to the effects of the local anaesthetic. This effect usually wears off within 12-24 hours. After which patients can start to see reductions in their pain as the benefits of the steroid start to work. This can take up to 1-2 weeks after the procedure. For those patients that the facet joint is the cause of their pain, up to 50% will experience relief and 30% can experience relief that can last up to 1 year. In patients who have at least 4 months of relief facet joint injections can be safely repeated. If the duration of benefit is less than 4 months than you may be a candidate for a Facet Joint (Medial Branch) Rhizotomy. Please refer to the Percutaneous Neurotomy information sheet for further details on this procedure.
It is important to recognise that facet joint injections are not a cure for your condition(s). It should be looked upon as a symptomatic treatment that can then be used to facilitate reduction in medication and improve quality of life and functioning. Any improvement to pain seen can be used to facilitate a rehabilitation approach to your management as guided by your treating doctor.
How is a facet joint injection completed?
Facet joint injections are a minimally invasive procedure that is completed in a clean operating theatre environment. It is usually completed as a day procedure and usually does not take more than 20 minutes. Throughout the entire procedure your heart rate, blood pressure and oxygen levels will be monitored. In addition to your doctor there will be an anesthetist who will monitor your care during the procedure.
- You will be given a sedative through a drip to relax you so that you are not aware of the procedure (this is not a general anesthetic).
- The procedure is completed under x-ray guidance to help direct the needle involved in the injection.
- The procedure may also involve injecting a special dye to confirm the correct location of the injection.
- The area to be injected will be cleansed with an antiseptic solution before a thin needle(s) is inserted. A local anaesthetic will be injected in the treatment area before the treatment needle is inserted to help numb the skin.
- A small amount of anaesthetic (and likely steroid) is then injected to block the facet joints and/or medial branch nerves.
Are there any risks?
The risk of complications with facet joint injections are low. There are risks associated with the procedure, medications used and the anaesthesia. For risks relating to the anaesthesia we recommend discussing this with your anaesthetist. Potential risks include:
Common (Usually mild and self-limiting)
- Bleeding at the injection site
- Bruising and discomfort at the site of injection
- Ineffective (up to 30% of patients)
- Steroid effects: elevated blood sugar levels, sleep disturbance, mood changes, facial flushing, sweating
- Nausea and/or vomiting
- Worsening of your pain
- Nerve or spinal cord damage
- Bleeding around the spinal cord
- Allergic reaction to medications
Is a facet joint injection right for you?
If you think a facet joint injection may be right for you talk to your doctor about it. If you would like any further information or would like to see one of our doctors please do not hesitate to contact Anodyne.