Facet Joint Injections

Cervical, thoracic or lumbar facet joint injections involve injecting a small amount of local anesthetic, and/or steroid medication. This injection can anesthetize the facet joints and block the pain. The pain relief from a facet joint injection is to help a patient better tolerate a physical therapy routine to rehabilitate an injury or back condition.

Facet joint injections usually have two goals: to help diagnose the cause and location of pain, and also provide pain relief:

• Diagnostic goals: By placing numbing medicine into the facet joint, the amount of immediate pain relief experienced by the patient will help determine if it’s a source of pain. If complete pain relief is achieved while the facet joint is numb, it means that joint is likely a source of pain.
• Pain relief goals: Along with the numbing medication, a facet joint injection also includes injecting time-release steroid (cortisone) into the facet joint to reduce inflammation. It can sometimes provide longer-term pain relief.

The facet joint injection procedure may also be called a facet block, as its purpose is to block the pain.

Facet joint injection is a relatively simple procedure and usually performed in an office based procedure suite or an ambulatory surgical center.

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.

The Facet Joint Injection

The injection procedure includes the following steps:

• Commonly, the procedure is performed without any sedation, however, an IV line can be started if relaxation medicine is needed.
• The patient lies on a procedure table, and the skin over the area to be tested is well cleansed.
• The physician treats a small area of skin with a numbing medicine (anesthetic), which may sting for a few seconds.
• The physician uses fluoroscopy to direct a very small needle into the facet joint.
• A small amount of contrast dye is injected to confirm the needle is in the joint and medication is contained inside the joint.
• Following this confirmation, a small mixture of anesthetic and anti-inflammatory medication is then slowly injected into the joint.

The injection itself only takes a few minutes, but the entire procedure usually takes between fifteen and thirty minutes.

Immediately Following the Injection

• After the procedure, the patient typically rests in the recovery area for twenty to thirty minutes. Then they are asked to perform some movements or activities that would usually provoke their pain.
• Patients may or may not obtain pain relief in the first few hours after the injection. Depending upon whether or not the joints targeted are the main source of their pain. If the joint or joints being targeted are not causing their pain, a patient will not obtain immediate relief from injection.
• Occasionally, patients may feel numbness, or slight weakness, or odd feeling in their neck or back for a few hours after the injection.
• The patient will discuss with the doctor any immediate pain relief, and any questions or concerns.

The Day of the Facet Joint Injection

On the day of the facet joint injections, patients are typically advised as follows:

• Avoid doing any strenuous activities.
• Patients should limit pain medicine within the first four to six hours after the injection so the diagnostic information obtained is accurate.
• Avoid driving, unless specifically approved by the treating physician.
  • If sedation was used, the patient should not drive for 24 hours after the procedure.

The Week after the Facet Injection

Patients may notice a pain increase lasting for several days as the numbing medicine wears off and before cortisone takes effect.

In the week following the facet joint injection, common recommendations include:

• If the area is uncomfortable in the first few days after the injection, carefully apply ice or a cold pack. This can help provide pain relief to the area.
• Patients may continue to take their regular pain medicine after the procedure.
• On the day after the procedure, patients may return to their regular activities.
• Patients may be referred for physical therapy or manual therapy after the injection. When the numbing medicine is effective and/or over the next several weeks while the cortisone is working.

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 to avoid recurrence of pain.