Facet joints are smaller joints at each vertebral segment of the spinal column that provide stability and help guide the movement of the spinal column. Just like any other joint in the body, facet joints can become painful due to arthritic changes in the spine, injury, or stress.
Cervical facet joint pain is usually felt in the head, neck, shoulder, and arm. Thoracic facet pain is usually felt in the upper back or chest area. Lumbar facet pain is usually felt in the lower back, hip, buttocks, and legs.
Facet joint injections involve injecting a steroid/anesthetic combination to anesthetize the joint and block the pain coming from that particular joint. In general a solution combining a steroid, such as triamcinolone, dexamethasone, and methylprednisone, and a local anesthetic, such as lidocaine or bupivacaine is used. The purpose of the steroid use is to inhibit the inflammatory response caused by the chemical or mechanical sources of pain. Additionally, steroids act on the immune system by reducing its reaction to the inflammation associated with nerve and/or tissue damage.
The purpose of a facet joint injection is both diagnostic and therapeutic. It is diagnostic in that it helps to diagnose the cause and location by providing instant pain relief in the area or no relief of the pain and therapeutic in providing pain relief and reducing the inflammation in the area.
Facet joint injections are done under fluoroscopy (live xray) and typically last between 30 to 45 minutes.
Prior to the procedure the patient is offered the choice to take a Xanax for anxiety an hour prior to coming in. This is not a necessity, but only used to help ease the anxiety the patient may be feeling prior to the injection. The patient will also need a driver to and from the office for the injection. Additionally the patient must stop either Coumadin or Plavix if they are taking it, but only as directed by their physician.
On the day of the injection, the patient will be asked to change into a gown, which allows the doctor access to the area of the back to be injected and to clean the area. The patient lies down on the table and the area of the neck/back to be injected is sterilized with betadine, which may present as a cold sensation on the area. The area is then numbed with a local anesthetic at the different levels that will be injected. Then under fluoroscopy a needle is inserted into the anesthetized area and into the facet joint. A small amount of contrast die is injected into the area to confirm that the medicine only goes into the joint. After confirmation the steroid/anesthetic combination is injected into the joint. The needle is removed and is repeated at each joint location as needed. Patients typically only feel a pinch and sting associated with the administration of the numbing medication, but only pressure with needle insertion.
After the injection the patient may feel tenderness at the site where the needle was injected, which can be treated by applying an ice pack for 10 to 15 minutes. The patients are also asked to take it easy for the rest of the day and normal activities may be resumed the following day. There is a chance that the patient may feel an increase in pain in the area over the next few days, due to increased pressure from the injected fluid but this should resolve.
For more detailed information or questions please contact your doctor. This information is not to be substituted for medical advice.
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