Facet Injection

Performed by Top Pain Management Doctors in San Antonio, Texas


Facet injections treat pain that originates from the facet joints in the spine. It’s a minimally-invasive procedure for reducing or eliminating chronic back and neck pain.

The injection consists of two types of medications; a short-term pain anesthetic, for immediate and short-term pain relief, and cortisone (steroid) to reduce overall inflammation for a longer pain relief.

Conditions commonly treated with Facet Injection include:

Anatomy

The spine has three sections; cervical (upper spine, neck), thoracic (middle spine) and lumbar (lower spine).

The spinal bone structure is called the vertebral column. The vertebral column has separate spinal bones (vertebrae). Each vertebra has two sets of facet joints. A joint is anywhere where two are more bones meet.

The facet joints connect the vertebrae together and assist with movement. They are located on the top and bottom of each vertebra. The facet joints have connective tissue and lubricating fluids, which allows for smooth spine movement. The facet joints enable movement and also provide stability for the spinal column.

Procedure

The patient lies on their stomach. The skin on the back or neck is sterilized and a local-numbing agent is administered into the injection site. Sedatives are often given to aid in relaxation.

During the procedure, the physician uses an imaging device, such as a fluoroscope. The fluoroscope, type of X-ray, acts as a guide for correct needle placement. The injection into the facet joints, are a combination of cortisone (steroid) and a short-term local pain medication (lidocaine, bupivacaine).

The steroid works to reduce inflammation and irritation; and the anesthetic works to stop the pain cycle.

The two-types of medicines spread into other spinal areas and aid in pain relief. The procedure usually takes less than15 minutes, and is relatively pain free. Typically patients go home within an hour after the procedure is completed. A small bandage is applied to the injection site.

Facet Injections and epidural steroid injections (ESI) are similar procedures. In an ESI, the medications are injected into the epidural space (area outside the spinal cord). In a facet injection, medications are injected into the joint structure.

Benefits

The most important benefit of a facet injection procedure is often the immediate pain relief. This often allows patients to become active again and resume their daily activities, without pain. This successful result may occur in cases when pain medications, physical therapy and other treatments alone weren’t highly successful.

An additional benefit of facet injections is its usefulness as a diagnostic tool. It aids in identifying if the pain is caused by the facet joints. If pain disappears, after the injection, then it proves pain most likely is caused by the facet joints.

Evidence suggests that therapeutic lumbar facet joint nerve blocks with local anesthetic, with or without steroids, may be effective in the treatment of chronic low back pain of facet joint origin. (Manchikanti 2007). However, if pain and other symptoms aren’t alleviated, then this also aids in a diagnosis.

A large evidence-based practice guideline (developed by the American Society of Interventional Pain Physicians) provided recommendations to clinicians and patients in the United States. This guideline states, the accuracy of facet joint nerve blocks is strong in the diagnosis of lumbar (lower back) and cervical (neck) facet joint pain (Boswell 2007).

Risks

Facet Injections are considered an acceptable treatment for chronic back and neck pain. Facet injections are generally considered safe; but with any procedure there are potential risks.

The potential risks with this procedure involve incorrect needle placement. Results of incorrect needle placement include:  nerve damage, bleeding, infection, and headache.

The other risks are often a direct result of the injected medications. Some possible side effects of corticosteroids include:  elevated blood sugars, weight gain, arthritis, stomach ulcers, and immune system problems.

Before any procedure, a patient should be assessed by a physician to see if the benefits outweigh the risks.

Patients with anesthetic allergies, take blood-thinning medications, have an active infection, or are pregnant are at a higher risk for complications and should speak with a physician before considering or receiving the procedure.

Outcomes

The amount of pain relief and duration varies for each person. It’s also dependent on a many individual health factors, such as pre-existing conditions and activity levels. Some people have longer periods of pain relief than others. For some it may be a few weeks, and for others it may be years. It’s crucial to honestly discuss with a physician the personal responses to facet injections, in order to obtain effective pain-management treatment. A facet injection may be repeated up to three times a year.

Lumbosacral (related to the spine) injections have dramatically increased in the Medicare population from 1994 to 2001. They are becoming even more prevalent today (Friedly 2007). They are more common, due to the significant percentage of people who experience back-pain relief.

In one study, a group of patients with back pain received facet injections. At eight weeks of treatment 53% of people reported pain relief and improvement; and by six months of treatment over 68% reported pain relief (Anand 2007).

For more information about facet injections, or other items mentioned, please see your pain physician.

Resources/Journal Articles

  1. Manchikanti L, Manchikanti KN, Manchukonda R, Cash KA, Damron KS, Pampati V, McManus CD. Pain Physician (2007 May 10) (3):425-40 PMID: 17525777
  2. Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a randomized, double-blind controlled trial: clinical trial NCT00355914.
  3. Friedly J, Chan L, Deyo R. Spine (2007 Jul 15);32(16):1754-60 PMID: 17632396. Increases in lumbosacral injections in the Medicare population: 1994 to 2001.
  4. Anand S, Butt MS. Acta Orthop Belg. (2007 Apr 73) (2):230-3 PMID: 17515236. Patients’ response to facet joint injection.
  5. Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L; (2007 Jan 10) Pain Physician. (1):7-111 PMID: 17256025. American Society of Interventional Pain Physicians. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain.