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Facet Injections

Facet Joints

What are Facet Joints?

Zygapophysial joints, better known as facet joints, are located on the back of the spine on each side of the vertebrae where it overlaps the neighboring vertebrae. The facet joints provide stability and give the spine the ability to bend and twist. They are made up of the two surfaces of the adjacent vertebrae, which are separated by a thin layer of cartilage. The joint is surrounded by a sac-like capsule and is filled with synovial fluid (a lubricating liquid that reduces the friction between the two bone surfaces when the spine moves and also nourishes the cartilage).

Why get a facet injection?

There are basically two reasons for having a facet joint injection: for diagnosis (to determine the source of pain) or for therapy (to treat an abnormality that has been detected.)

Most back pain will improve within a few weeks by itself, or with conservative treatments such as rest, antiinflammatory medications, physical therapy and exercise. If you suffer from back pain for more than six weeks and conservative treatments have not helped, or if your pain has increassed, your surgeon may order diagnostic tests such as magnetic resonance imaging (MRI) to look at the structures of the spine. A problem (such as inflammation, irritation, swelling or arthritis) in the facet joint may cause low back pain. If these diagnostic tests show an abnormality in a facet joint, it may be the source of the pain.

To determine if a facet joint is truly the source of back pain, an injection (sometimes called a “block”) may be prescribed. If an injection of a small amount of anesthesia into the facet joint reduces or removes the pain, your surgeon is assured that the facet joint is the source of the pain. This is diagnostic use of the facet injection.

Once a facet joint is pinpointed as a source of pain, therapeutic injections of anesthesia and anti-flammatory medications may give pain relief for longer periods of time. Back to top

How are injections performed?

Facet joint injections are performed while you are sedated. You are still able to communicate. The injection is usually performed while you are lying on your stomach on an X-ray table.

During the procedure, you probably will undergo a fluoroscopic X-ray that allows your surgeon to place the syringe in the correct facet joint. Your surgeon will clean and sterilize the area of the back directly over the affected joint. Needle placemnt is checked on the image intensifier.

Once the proper site has been determined, your surgeon will inject the anesthetic (often lignocaine or bupivicaine) and the anti-inflammatory (usually a corticosteroid.) . When the the actual medication is injected into the joint capsule, you may feel the typical discomfort of back pain that you experience on a day to day basis..

This process may then be repeated depending on the number of affected facet joints. Although the actual injection takes only a few minutes, the overall procedure usually takes approximately 15 to 20 minutes. Back to top

Are there any special precautions?

You should have no food or drink (including water) for at least four hours before the procedure. However, if you are an insulin dependent diabetic, inform your health care provider; you may not need to change your normal eating habits prior to the procedure. If you need to take medication within four hours before the procedure, a sip of water may be allowed; however, you should check with your surgeon prior to taking any medication before the injection.

You may be asked to remove most of your clothing for the procedure and wear a gown that opens in the back to allow access to your spine. Back to top

What happens after the injection?

Immediately following the procedure, you may feel a reduction or complete relief of your back pain. Your health care provider may ask you to perform a task that would normally cause pain to assess the level of pain relief. You will be able to walk immediately after the procedure, although some patients may experience leg weakness, numbness or tingling for a few hours after the injection. Because your reaction times may be affected by the medications, driving is not recommended immediately following the injection. You probably should have someone who is able to drive you home following the procedure.

Once home, you can treat any pain you may have at the injection site with ice or a pain medication prescribed by your health care provider. It is generally recommended that you take it easy and not exert yourself for the first day. After the anesthetic component of the injection wears off, your back pain may return. It may take seven to ten days for the steroid component of the injection to relieve the pain. After the first day, you can usually return to your daily activities as your pain will allow; however, you should check with your health care provider to get his or her recommendations on specific activities that will be allowed. In most cases, you can return to work the day following the injection. Back to top

How effective are facet injections?

The effectiveness of facet injections for the treatment of low back pain is controversial. No medical study has definitively identified the facet joint as the cause of low back pain. Research has found that facet injections can give relief of lower back pain for longer than six months in 18-63% of patients who underwent the procedure. It has been recommended that facet injections be used as a method to allow the patient to be able to perform other forms of conservative treatment (such as physical exercise, yoga and stretching and bending), rather than using it as a stand-alone pain treatment.

If you do not get relief from your pain following the first therapeutic facet injections, further treatments by injection are not recommended. Back to top

Who should not receive facet injections?

You should not undergo facet injections for the treatment of low back pain if your pain has not been present for at least four to six weeks and if other forms of conservative treatment have not been tried. If you are prone to excessive bleeding or are taking an anticoagulant medication (such as warfarin or heparin), this procedure is not recommended; you should notify your surgeon if you are taking these medications. Back to top

Are there any side effects?

There is a possibility of side effects with just about any medical procedure and you should always discuss that possibility with your surgeon before undergoing any treatment. Possible side effects from facet injections include pain at the injection site, bleeding, infection or a worsening of the pain symptoms. This is usually temporary.

If the facet block procedure is effective in alleviating the patient's low back pain, it is often considered reasonable for the procedure to be done up to three times per year. There are very few risks associated with this technique and these will be discussed with you during the consultation. Back to top

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