Facet Injections

What are facet injections?

Facet injections are spinal injections that deposit medications into the actual joints of the spine called the facet joints, which are located between each vertebrae throughout the course of the entire spine from the neck all the way down to the tailbone. Facet joints are important joints because the allow each level of the spine to move and rotate alongside the vertebrae right above and right below it..

What is the purpose of facet injections?

Facet injections help decrease back pain by decreasing inflammation and irritation around the facet joint. are used to reduce the inflammation and swelling of tissue in and around the facet joint space. Facet joint pain can either be located primarily in the spine or it can also be referred into surrounding tissues and sometimes even into the shoulders and arms or buttocks and legs.

Am I a candidate for facet injections?

Patients with chronic back or neck pain or arthritis in their facet joints on imaging are the typical candidates for facet joint injections. Patients with facet arthritis typically have developed chronic spine pain, which is worse with movement such as bending and twisting and certain postures and could benefit from facet joint injections. Facet joints arthritis and inflammation can develop over time with wear and tear or be caused by whiplash injuries as well as trauma. Many patients who present for facet injections have already tried conservative treatments, such as anti-inflammatory medication, chiropractic or physical therapy.

How long do the facet injections take?

Facet injections take approximately 10-20 minutes to complete.

What is actually injected?

Facet injections often include both local anesthetic as well as steroid medication.

Will the facet injections hurt?

In order to minimize your pain, we numb the skin with local anesthetic before inserting a needle in the facet joints. For extra comfort, some patients also prefer to have intravenous sedation as well.

Will I be “put out” for this procedure?

No. This procedure is typically done under local anesthesia. Some patients may also have intravenous sedation, which can make the procedure more comfortable.

The actual amount of sedation given depends on patient tolerance. Sedation is “titrated to effect,” which means that the minimal amount of sedation is given to you to give you comfort, but also maintain your safety. The amount of sedation given generally depends upon each patient’s tolerance. Some patients may experience amnesia and not remember all of even part of the procedure.

How are the facet injections performed?

Facet injections are performed under X-ray guidance with patients lying on their belly. Patients receiving intravenous sedation are also being continuously monitored with EKG, a blood pressure cuff and blood an oxygen-monitoring device. An antiseptic solution is used to clean the skin of the back or neck and the injection is performed. Depending on your condition, you may only have one side of your back injected during one procedure. In addition, no more than three or sometimes four joints are injected at any one visit.

What should I expect after the facet injections?

Patients may feel partial or complete relief of their symptoms immediately after the injection. This immediate relief is due to the local anesthetic in the injection and usually only lasts for a few hours. Your pain may return and you may then have a sore neck or back for the next 24-48 hours. The soreness is due to the procedure itself. By this time, the steroid medication may also begin to take effect to begin giving you longer term relief.

What should I do after the facet injections?

On the day of your epidural injection, please have someone designated to drive you home. You will take it easy and rest for the remainder of the day. We recommend you only perform light activities that you can tolerate. After a day or so, you may increase your activity level slowly.

However, most patients can perform any activity that they could perform before the procedure.

You may want to apply ice to the injection sites to keep it from getting sore the following day. Otherwise, you should be able to perform your baseline level of activity that you could do before the facet injections and possibly more if you begin feeling pain relief.

We do not advise that you test the limits right away. Build your activity level slowly over time to avoid injury and exacerbation of pain symptoms.

Can I go to work to work the next day?

The vast majority of patients return to work the next day. Unless there are unforeseen complications, the most common side effect you may feel is soreness at the injection site.

How long does the effect of the medication last?

The immediate pain relief lasts for a few hours and this is due to the local anesthetic that is injected. The steroid medication begins to take effect between 2-7 days after the injection, but its effect can last several days to months.

How many facet injections do I need to have?

For any particular facet joint, there is a possibility that you may only ever need just one injection for ongoing relief.
In addition to being therapeutic, facet injections are also often performed as diagnostic injections to confirm that a specific facet joint or group of joints is the actual cause of the neck or back pain.

Once this confirmation is made, most patients will be candidates for a procedure called a rhizotomy, that includes heating the nerves that are responsible for the pain to decrease painful sensation for a much longer period of time than a facet joint injection. Addressing all of the involved facet joints may take several visits. Likewise, some patients who get a prolonged response from simple facet injections may choose to have a facet joint repeated rather than go on to a facet rhizotomy, although that is the exception, not the rule.

Can I have more than three or four facet injections at once?

For many, reasons, we generally do not perform more than three, or occasionally four, injections during one visit. Patients often can experience increased soreness with increased number of injection sites. In addition, some patients who have a wide area of neck and/or back pain can often do equally as well with just targeting the most tender sites rather than all of their pain sites. In addition to these clinical indications, although bizarre, some insurers will also only cover three facet injections on any given date of service.

Will facet injections help me?

Although it is difficult to predict with 100% accuracy, we do know that patients who have recent (acute) onset of pain may respond much better than the ones with long standing (chronic) pain. However, facet injections can be very effective for those patients whose pain is truly coming from facet arthritis or inflammation, no matter how long the symptoms have been present.

What are the risks and side effects of facet injections?

In general, facet injections are extremely safe. However, all procedures come with risks, side effects and potential for complications.

Some temporary side effects and minor complications include soreness, bruising, and pain at the injection site. Very rare and uncommon risks also include infection, bleeding, nerve damage or worsening of original symptoms. There are potential risks also related to the side effects of the long acting steroid which is injected for pain relief, including weight gain, increase in blood sugar, water retention or suppression of body’s own production of steroids.

Who should not have facet injections?

Patients who have an allergy to any of the medications that are injected, are on blood thinners as a part of their medication regimen, have an active infection or have poorly controlled diagnoses such as diabetes or heart disease may not be good candidates for an epidural injection and may have to be postponed until their medical condition improves.