Facet Joint Injection

What is a Facet Joint Injection?
A facet joint injection is an injection of an anesthetic with a long lasting steroid ("cortisone") in the Facet joints. Facet joints are located in the back and neck at each vertebral level. They are paired (right and left) and are surrounded by a joint capsule like the finger joints.

What is the purpose of it?
The steroid injected reduces the inflammation in the joint space. This can reduce pain, and other symptoms caused by inflammation such as nerve irritation.

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 novocaine) and the steroid medication . Many times prior to injecting the medicine, a small volume of contrast dye is used to confirm proper needle placement.

Will the injection(s) hurt?
This procedure is done under local anesthesia. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate. The amount of sedation given generally depends upon the patient tolerance.

How is the injection performed?
It is done with the patient lying on the stomach with fluoroscopic (x-ray) guidance. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin in the back is cleaned with antiseptic solution and then the injection is carried out. After the injection, you are placed on your back or on your side.

What should I expect after the injection?
Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last for a few hours. Your pain may return and you may have a sore back or neck 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 3rd to 5th day.

What should I do after the procedure?
You should have a ride home. We advise patients to take it easy for the day of the procedure. You may want to apply ice to the affected area. After the first day, you can perform activity as tolerated.

Can I go to work to work the next day?
Yes. Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is soreness in the neck or back.

How long the effect of the medication lasts?
The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about 5 to 7 days and its effect can last for several days to many months.

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, you may be recommended for a third injection, or a different procedure.

Can I have more than three injections?
In a six-month period, we generally do not perform more than three injections. Giving more than three injections will increase the likelihood of side effects from cortisone. Also, if three injections with fluoroscopic guidance have not helped you much, it is very unlikely that you will get any further benefit from additional injections.

Will the Facet Joint Injection help me?
It is very difficult to predict if the injection will help you or not. Usually, patients who have recent onset of pain may respond better than the ones with long standing, or chronic pain. Your physician chose this procedure for you because he/she believes that the potential benefits of an injection outweigh any potential risks.

What are the risks and side effects?
This procedure is safe when performed in a controlled setting (surgical center sterile equipment, and the use of x-ray.) However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is discomfort - which is temporary. The other risks involve, infection, bleeding, worsening of symptoms. As with other types of injections, you should not have the procedure if you are currently taking blood-thinning medicine (Coumadin.) Side effects related to cortisone include: fluid retention, weight gain, increased blood sugar (mainly in diabetics,) elevated blood pressure, mood swings, irritability, insomnia, and suppression of body’s own natural production of cortisone. Fortunately, the serious side effects and complications are uncommon. You should discuss any specific concerns with your physician.