Overview
A facet injection is a nonsurgical treatment that can temporarily “block” pain in your neck and back from inflammation or irritation of the facet joints in your spine. The procedure has two purposes. First, it can be used as a diagnostic test to see if the pain is actually coming from your facet joints; and second, it can be used as a treatment to relieve inflammation and pain caused by:
- Spinal stenosis: a narrowing of the spinal canal and nerve root canal causing back and leg pain, especially when walking.
- Spondylolysis: a weakness or fracture between the upper and lower facets of a vertebra. If the vertebra slips forward, called spondylolisthesis, it can compress the nerve roots causing pain.
- Herniated disc: occurs when the gel-like center of an intervertebral disc pushes out from the center, similar to the filling being squeezed out of a jelly doughnut. Pain results when the disc material touches a nearby nerve.
- Sciatica: pain that courses along the sciatic nerve in the buttocks and down the legs. Usually caused by compression of the 5th lumbar spinal nerve.
The effects of facet injections tend to be temporary – providing relief from one week up to one year. Successful facet injections may indicate that you could benefit from a facet rhizotomy.
What is a facet injection?
It is an injection of both a long-lasting steroid “cortisone” (like triamcinolone or methylprednisolone) and an anesthetic numbing agent (like lidocaine or bupivacaine) into a specific facet joint of your spine. The injection can be placed inside the joint capsule or in the tissue surrounding the joint capsule. Corticosteroids reduce inflammation, and they’re very effective when delivered directly into the part of your back that is causing pain. Corticosteroids are different than the anabolic steroids that athletes may use.
The facet joint is the moveable joint of the spine that connects one vertebra to another (see Anatomy of the Spine). This procedure is different than an epidural steroid injection, which injects the steroid into the epidural space of the spinal cord.
Facet injections may provide relief of pain and inflammation as well as provide more diagnostic information for your physician. The injection “blocks” the pain in much the same way as your dentist would use an anesthetic injection to block pain in your jaw before working on your teeth. Injections into joints or nerves are sometimes called “blocks.” Facet blocks can be used as a diagnostic test to determine if you will benefit from a facet rhizotomy. The pain relief can last from days to years, or in some cases, permanently.
Am I a candidate for facet injection?
If you have neck, low back, or leg pain (sciatica) stemming from inflammation or irritation of your facet joints you may benefit from a facet injection. It’s usually recommended only if you do not respond to other conservative means, such as oral anti-inflammatory medication, rest, back braces or physical therapy. The doctor may wish to perform it as a diagnostic test to find the facet joint that may be causing your pain. Even if you are not a surgical candidate for some reason, facet injections may be helpful in treating your inflammatory condition. If you are in too much pain to exercise, facet injections can ease your pain enough so that you can continue with your rehabilitation program.
Facet injections should not be performed on people who have an infection, are pregnant, or have bleeding problems. If you have diabetes, it may elevate your blood sugar.
Who performs facet injections?
Many types of doctors perform epidural steroid injections including anesthesiologists, radiologists, physiatrists, neurologists, and surgeons.
What happens before treatment?
The doctor who will perform the injection may evaluate you a few days before your appointment. A medical history and physical exam, as well as a review of your imaging studies may be performed. This will help your doctor plan the best way to place the medication as close to the site of pain as possible. Be prepared to ask any questions you may have at this appointment.
If you are currently taking any aspirin or blood thinning medication, you may need to stop taking it several days before the facet injection. Please discuss this with the doctors who prescribed this medication as well as the doctor who will be giving you the injection.
Make arrangements to have someone drive you to and from the hospital the day of your injection.
What happens during treatment?
At the time of your injection, you will be asked to sign consent forms, list medications you are presently taking, and if you have any allergies to medication. The entire procedure usually lasts about 10-15 minutes.
Step 1: Prepare the patient
The injection is usually performed in the Special Procedures suite in the Radiology Department. You’ll put on a patient gown and lie face down on the table. Your back will be cleansed and may be covered by sterile towels. A local anesthetic is given to numb the skin near the injection site. You will remain awake for the entire process, though you might be sedated. You will have your blood pressure, heart rate and breathing monitored during the procedure.
Step 2: Insert the needle
Facet injections are performed using a C-arm fluoroscope (a special X-ray TV) to direct a long needle through the skin and muscles of your back to the path of the sensory nerves that are located in the facet joints. The doctor watches on the fluoroscope to make sure that the needle goes to the correct facet joint (Fig. 1). There is some discomfort involved; however, the tissues in the middle of your back have less nerve supply, so you’ll feel more pressure than pain.
Step 3: Inject the medication
When the needle is in correct position, the doctor injects a mixture of anesthetic and cortisone into your facet joint capsule (Fig. 2). The needle is then removed.
What happens after treatment?
Most patients are able to walk immediately after the procedure without using a recovery room or hospitalization. You’ll be monitored for a short period of time before you can leave and are expected to take it easy for 24-36 hours after the injection to allow the anti-inflammatory medicine to take effect.
In 3 to 5 days the doctor’s office will call and ask about the level of pain relief obtained from the procedure.
What are the results?
About 50% of patients experience some degree of pain relief. The pain may be relieved for several days to several months. If the first injection provided some relief, the procedure can be repeated up to 3 times a year. If you don’t have any benefit, further injections won’t likely be helpful. The primary purpose of facet injections is to determine if you would benefit from other treatments or surgery.
If you’ve experienced good pain relief with three facet blocks, you may be a candidate for facet rhizotomy. Facet rhizotomy permanently destroys the nerve fibers that are causing pain. In this procedure, an electrode is passed through the skin to the nerves surrounding the facet joint. Once the electrode is in the exact position a heating current is applied to the nerve to disable the pain signals. This procedure is not reversible and you will have numbness in the area.
What are the risks?
Generally, there are few risks, which is why facet injections are considered an appropriate nonsurgical treatment for some patients. Potential side effects, which affect about 5% of patients, include facial flushing, low grade fever, and insomnia. These usually disappear within 3 days. Patients who are being treated for chronic conditions (e.g. heart disease, diabetes, rheumatoid arthritis) need to discuss this with the doctor.
Sources & links
If you have more questions, please contact the Mayfield Spine Institute at 800-325-7787 or 513-221-1100. Additional information is available on the web.
Links
www.SpineUniversity.com
www.LowBackPain.com
www.Spine-Health.com
Glossary
anabolic steroid: any steroid compound that promotes muscle growth.
anesthetic: an agent that causes loss of sensation with or without the loss of consciousness.
chronic: a condition of slow progression and continuing over a long period of time, opposite of acute.
corticosteroid: a hormone produced by the adrenal gland or synthetically. Regulates salt and water balance and has an anti-inflammatory effect.
facet joints: joints located on the top and bottom of each vertebra that connect the vertebrae to each other and permit back motion.
facet rhizotomy: a procedure in which a probe is heated with radio waves then applied to the nerve at the facet joint to disable the nerve. The procedure may be performed if three facet blocks provide good relief of pain.
fluoroscopy: an imaging device that uses x-ray or other radiation to view structures in the body in real time, or "live." Also called a C-arm.
herniated disc: a condition in which disk material protrudes through the disk wall and irritates surrounding nerves causing pain.
sciatica: pain that courses along the sciatic nerve in the buttocks and down the legs. Usually caused by compression of the 5th lumbar spinal nerve.
spinal stenosis: the narrowing of the spinal canal and nerve-root canal along with the enlargement of the facet joints.
spondylolysis: a breakdown or destruction of the vertebra.
updated: 6.2004
reviewed by: Lester Duplechan, MD and Theresa Greenwald, RN |
