Facet joint injections are an increasingly common treatment for chronic pain of the neck and lower back. Before getting facet joint injections for chronic pain, it’s important to understand how they work, what conditions they are used for, and any risks associated with treatment.
Anatomy of facet joint injections
To understand how facet injections can help with chronic pain, it is first important to know a little bit about the anatomy of the spine. Facet joints are located between each vertebrae of the neck and along the bony ridge of the lumbar spine. They are protected by cartilage and surrounded by synovial fluid that lubricates the entire joint and reduces friction when these joints move.
Facet joints allow movement in the neck and the lower torso. This movement can be greatly decreased when facet joints begin to degenerate or there is pain originating anywhere along the spine due to injury or another condition. Facet joint degeneration can cause inflammation and pain. This inflammation can lead to a decrease in the range of motion in the lower back and neck.
What conditions do facet joint injections treat?
In addition to facet joint degeneration, facet joint injections can also be used for the following conditions:
- Spinal stenosis: This narrowing of the spinal column can place pressure on the nerves of the low back.
- Arthritis: Wear-and-tear conditions such as osteoarthritis can be treated by facet joint injections.
- Whiplash: Facet joint injections can treat pain due to neck injuries caused by car accidents, most commonly whiplash.
- Injury: Any injury to the facet joints in the lower back can also be treated with facet joint injections.
- Herniated discs: This condition occurs when vertebral disc material is pushed out from in between the vertebrae, allowing bone-on-bone contact and compression of nerves.
Facet joint injections are not only intended to treat pain. They can also be used as a diagnostic tool. If a facet joint injection works to block pain, this can be valuable information for diagnosis of a particular condition.
For pain relief, facet injections can be a temporary treatment that allows a patient to participate in physical therapy and exercise for long-term relief. Some back pain conditions require physical therapy and exercise that back pain makes impossible. Facet joint injections can relieve pain and inflammation and allow a patient to begin physical therapy sooner.
How are facet joint injections performed?
Facet joint injections are minimally-invasive, outpatient procedures that can be performed in just a couple hours. Patients usually only receive a local anesthetic, but in some cases they may opt for general sedation. In the case of general sedation, the procedure will take a little longer, as patients must be monitored as they come out of anesthesia.
Patients will lie face down on the examining table. The area to be injected will be cleaned and numbed with a topical numbing agent before a local anesthetic is administered. Patients who are sedated will be sedated prior to this and have their breathing carefully monitored.
The doctor will insert a needle using fluoroscopy to ensure proper placement. Once the needle is in place, guided also by a harmless fluoroscopic dye, an anesthetic and a steroid will be injected into the facet joint, and the needle will be removed. This portion of the procedure takes about 15 minutes.
Side effects and risk factors for facet joint injections
This is a minimally-invasive procedure but not without risks. Patients may experience bruising, soreness, and bleeding at the injection site, but most of these will be minor. In rare cases, more severe side effects may occur. These can include:
- Infection at the injection site
- Allergic reaction to the steroid or anesthetic
- Difficulty with sedation
- Nerve damage
Side effects from the steroids themselves can also include
- Weight gain
- Face flushing or redness
- High blood sugar
There are some people for whom facet joint injections pose a higher risk of complications. People in generally poor health or with a poorly managed health conditions may not be good candidates for facet joint injections. Because blood sugar can be elevated by facet joint injections, patients with diabetes should be careful.
If you believe that facet joint injections may help with your chronic cervical and lumbar pain, talk to your doctor today.