What is a Facet Joint Injection?
Facet Joint Injection is an injection of long lasting steroid ("cortisone") in the facet joints - which are located in the back area the spinal bony structure. These joints are actual joints with joint capsule that contains lubricating fluids.
What is the purpose of a Facet Joint Injection?
The steroid injected reduces the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain, and other symptoms caused by inflammation / irritation of the joint and surrounding structures.
How long does the injection take?
The actual injection takes only a few minutes.
What is actually injected?
The injection consists of a mixture of local anesthetic (like lidocaine or bupivacaine) and the steroid medication (methylprednisolone - Depo-medrol®).
Will the injection(s) hurt?
The procedure involves inserting a needle through skin and deeper tissues (like a "Flu shot"). There is some mild discomfort involved. However, the skin and deeper tissues are numbed with a local anesthetic using a very thin needle prior to inserting the treatment needle.
Will I be "put out" for this procedure?
No. This procedure is done under local anesthesia. Sometimes patients also receive a pill given by mouth that is sedating, which makes the procedure easy to tolerate.
How is the injection performed?
It is done either with the patient lying on the stomach, or for the cervical (neck area) injections - in supine position, under x-ray control. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin on the back is cleaned with antiseptic solution and then the injection is carried out. After the injection, the patient is placed on their back or on their side.
What should I expect after the injection?
Immediately after the injection, you may feel that your pain may be gone or quite lessened. This is due to the local anesthetic injected and may last only for a few hours. Your pain will return and you may have a "sore back" for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation form the steroid itself. You should start noticing pain relief starting the fifth day or so.
What should I do after the procedure?
You should have a ride home. We advise that you should take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform normal activities as you can tolerate.
Can I go to work the next day?
Unless there are complications, you should be able to return to work the next day. The most common discomfort you may feel is a sore back.
How many injections do I need to have?
If the first injection does not relieve your symptoms in about a week to two weeks, you may be recommended to have one more injection. If you respond to the injections and still have residual pain, it may be recommended to have a third injection.
Can I have more than three injections?
In a six-month period, we generally do not perform more than three injections. This is because the medication injected lasts for about six months. If three injections have not helped you much, it is very unlikely that you will get any further benefit from more injections. Administering more injections will increase the likelihood of side effects from cortisone.
Will the Facet Joint Injection help me?
It is very difficult to predict if the injection will indeed help you or not. Generally speaking, patients who have recent onset of pain may respond much better than patients with long standing pain.
What are the risks and side effects?
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain - which is temporary. Risks involve, infection, bleeding, worsening of symptoms, spinal block, epidural block etc. The risks related to the side effects of cortisone include weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of body's own natural production of cortisone etc. Fortunately, the serious side effects and complications are uncommon.
Who should not have this injection?
If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Coumadin®), or if you have an active infection, you should not have the injection.
