Facet Joint Injections

What are Facet Joint Injections?

Facet Joint Injections are a minimally invasive non-surgical treatment that is used as treatment for many different causes of neck and back pain. It works by reducing the inflammation and irritation in the facet joints of the spine that is causing you pain.

The syndromes most commonly requiring Facet Injections include:

• Spinal Stenosis
• Herniated Disk
• Sciatica
• Spondylolysis

Facet Joint Injections – Procedure

The facet joint of the spine is a moveable connection that connects one vertebra (bone of the spine) to another. This injection includes both a long-lasting steroid and an anesthetic (lidocaine, bupivacaine). The steroid reduces the inflammation and irritation and the anesthetic works to numb the pain. The combination medicine then spreads to other levels and portions of the spine, reducing inflammation and irritation. The entire procedure usually takes less than 15 minutes.

The Facet Joint Injections and the Epidural Steroid Injections (ESI) are very similar and differ in the location that they inject the medicine. In an ESI, the medication is injected into the epidural space whereas in the facet injections, it is injected directly into the joint.

Facet Joint Injections – Benefits

The most important and greatest success achieved with the use of facet joint injections is the rapid relief of symptoms that allows patients to experience enough relief to become active again. With this they regain the ability to resume their normal daily activities that was not achieved with oral medications and physical therapy.

Another benefit to the use of facet joint injections is that it can be used as a diagnostic test to see if the pain is actually coming from the facet joints. If your pain disappears with the injection then it is clear that the pain is originating from the joint, and it has been shown that therapeutic lumbar facet joint nerve blocks with local anesthetic, with or without steroids, may be effective in the treatment of chronic low back pain of facet joint origin. (Manchikanti 2007). However, if your pain is unresponsive then this gives your physician information that can help him in diagnosing your condition.

A large evidence-based practice guideline for the management of chronic spinal pain with interventional techniques was developed by the American Society of Interventional Pain Physicians provide recommendations to clinicians and patients in the United States. In regards to the facet joint injections they states that the accuracy of facet joint nerve blocks is strong in the diagnosis of lumbar and cervical facet joint pain (Boswell 2007).

Facet Joint Injections – Risks

With a minimal amount of risks, facet joint injections are considered an appropriate non-surgical treatment for many patients who suffer from back pain. The associated risks with this procedure involve misplacement of the needle, either advancing the needle too deeply or positioning it incorrectly. The outcome of the incorrect positioning of the needle can potentially cause nerve damage, bleeding, infection, and a headache following the injection.

As with any medication taken, there are always risks and potential side effects that may occur. The other risks of the facet injections may be directly caused by the actual medication given, however, the risk of developing these side effects are much higher in a person taking oral corticosteroids. Some of the potential side effects of the corticosteroid may include elevated blood sugars, weight gain, arthritis, stomach ulcers, and transient decrease in the immune system. All patients before receiving a facet injection should be assessed by their physician about risk assessment for the procedure.

Facet Joint Injections – Outcome

Lumbosacral injections have increased dramatically in the Medicare population from 1994 to 2001 and are becoming even more popular today (Friedly 2007). They are being used more frequently because they have provided very successful results in the treatment of back pain.

In research study a group of patients with back pain received facet joint injections and at 8 weeks of treatment 53% of people reported improvement of their pain and by 6 months of treatment over 68% reported the same (Anand 2007). The duration of pain relief varies from each individual but if the first facet injection provides relief then the procedure can be repeated up to 3 times a year.

References

Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a randomized, double-blind controlled trial: clinical trial NCT00355914. Manchikanti L, Manchikanti KN, Manchukonda R, Cash KA, Damron KS, Pampati V, McManus CD. Pain Physician. 2007 May;10(3):425-40 PMID: 17525777

Increases in lumbosacral injections in the Medicare population: 1994 to 2001 Friedly J, Chan L, Deyo R. Spine. 2007 Jul 15;32(16):1754-60 PMID: 17632396

Patients’ response to facet joint injection. Anand S, Butt MS. Acta Orthop Belg. 2007 Apr;73(2):230-3 PMID: 17515236

Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Boswell MV,Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB,Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L; American Society of Interventional Pain Physicians. Pain Physician. 2007 Jan;10(1):7-111 PMID: 17256025

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