About Facet Joint Injections
Facet join injections usually have two goals: to help diagnose the cause and location of pain and also to provide pain relief.
Facet joints are small joints at each segment of the spine that provide stability and help guide motion. The facet joints can become painful due to arthritis of the spine, a back injury or mechanical stress to the back. A cervical (neck), thoracic (upper back) or lumbar (lower back) facet joint injection involves injecting a steroid medication, which can anesthetize the facet joints and block the pain. The pain relief from a facet joint injection is intended to help a patient better tolerate a physical therapy routine to rehabilitate his or her injury or back condition. Download fact sheet (PDF) »
During the procedure
As with many spinal injections, facet joint injections are best performed using fluoroscopy (live X-ray) for guidance to properly target and place the needle (and to help avoid nerve injury or other injury).
The injection procedure includes the following steps:
- An IV line will be started so that adequate relaxation medicine can be given, if needed.
- The patient lies face down on an X-ray table and the skin over the area to be treated is well cleaned.
- The physician numbs a small area of skin with an anaesthetic (a numbing medicine). This may sting for a few seconds.
- The physician uses X-ray guidance (fluoroscopy) to direct a very small needle into the joint. Several drops of contrast dye are then injected to confirm that the medicine only goes into the joint.
- A small mixture of anaesthetic and anti-inflammatory medication (cortisone) is then slowly injected into the joint.
The injection itself only takes a few minutes, but the entire procedure usually takes between thirty and sixty minutes. After the procedure, the patient typically remains resting on the table for twenty to thirty minutes, and then is asked to move the area of usual discomfort to try to provoke the usual pain. Patients may or may not obtain pain relief in the first few hours after the injection, depending upon whether or not the joints that were injected are the main source of the patient’s pain. On occasion, the patient may feel numb or experience a slightly weak or odd feeling in the upper back for a few hours after the injection. On the day of the injection, patients are advised to avoid driving and avoid doing any strenuous activities.
The patient should record the levels of pain relief during the next week in a pain diary. Tracking the level of pain is helpful to clearly inform the treating physician of the injection results and in planning future tests and/or treatment, as needed.
You will need to make an appointment for this examination and will also need to arrange a driver. You may eat and drink as you wish before and after the procedure.
Please advise our receptionists if you take any blood thinning medication, such as warfarin, as this may require you to take blood tests prior to the procedure.
You will be asked to sign a consent form prior to the procedure.
Following the procedure
On the day of the injection, patients are advised to avoid doing any strenuous activities, unless instructed by their doctor. The patient should not drive the day of the injection unless approved by the treating physician. If sedation was used, the patient should not drive for 24 hours after the procedure. Patients may notice a slight increase in pain lasting for several days as the numbing medicine wears off and before the cortisone starts to take effect. If the area is uncomfortable in the first two to three days after the injection, carefully applying ice or a cold pack to the general area of the injection site will typically provide pain relief.
If the facet joints that were treated are the source of the pain, the patient may begin to notice pain relief starting two to five days after the injection. If no improvement occurs within ten days after the injection, then the patient is unlikely to gain any pain relief from the injection and further diagnostic tests may be needed to accurately diagnose the patient’s pain.
Patients may continue to take their regular pain medicine after the procedure, with the exception of limiting pain medicine within the first four to six hours after the injection so that the diagnostic information obtained is accurate. Patients may be referred for physical therapy or manual therapy after the injection while the numbing medicine is effective and/or over the next several weeks while the cortisone is working.
On the day after the procedure, patients may return to their regular activities. When the pain is improved, it is advisable to start regular exercise and activities in moderation. Even if the pain relief is significant, it is still important to increase activities gradually over one to two weeks to avoid recurrence of pain.
If the face block procedure is effective in alleviating the patient’s back pain, it is often considered reasonable for the procedure to be done up to three times per year. However, if the first facet joint injection does not relieve the patient’s pain then the injection should not be repeated.
Potential risks and complications
As with all invasive medical procedures, there are potential risks and complications associated with facet join injections. However, in general the risk is low, and complications are rare. Potential risks and or complications that may occur from a facet joint injection include:
- Allergic reaction. Usually an allergy to X-ray contrast or steroid; rarely to local anaesthetic
- Bleeding. A rare complication, bleeding is more common for patients with underlying bleeding disorders.
- Infection. Minor infections occur in less than 1% to 2% of all injections. Severe infections are rare, occurring in 0.1% to 0.01% of injections.
- Worsening of pain symptoms
- Discomfort at the point of the injection
- Nerve or spinal cord damage or paralysis. While this is extremely rare, damage could possibly occur from direct trauma from the needle, or secondarily from infection, bleeding resulting in compression, or injection into an artery-causing blockage.