Facet Joint Injection- Indications and Complications

Facet joint injection is given to diagnose and treat pain originating from facet joint of spine.

Facet joint are small but important joints between superior and inferior articular processes. These joints provide  stability and help guide motion.

These joints can become painful and cause pain in the back following  arthritis of the spine, a back injury, or mechanical stress to the back.

A facet joint injection involves injecting a small amount of local anesthetic (numbing agent) and/or steroid medication, which can anesthetize the facet joints and block the pain.

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

Facet joint injection can be applied in cervical, dorsal or lumbar region.

Indications for Facet Joint Injections

Diagnosis

Facet joint injection can be used to diagnose the facet joint as the pain generator of  back pain. After the injection, if the complete pain relief is achieved immediately while the facet joint is numb, it means that joint is likely a source of pain.

Diagnosis is done by injecting anesthetic agent like lidocaine.

Pain relief

For this, steroid is injected along with anesthetic agent. Steroids work on reducing the inflammation and provides long-term pain relief.

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Facet Joint Anatomy

The facet joints are paired synovial joints formed by articulation of articular facets of superior and inferior vertebrae.

Typically, Each vertebra has four articular facets – two superior and two inferior.

Superior articular facets of lower vertebra articulates with inferior articular processes of upper vertebra to form a pair of facet joints.

Thus each vertebra participates in facet joint formation with a vertebra above and a vertebra below.

Facet joints are  surrounded by a capsule surrounding capsule filled with synovial fluid.

The position and orientation of facet joints varies with the region of the spine.

Procedure of Facet Joint Injection

• Usually, the procedure is performed without any sedation
• The patient is placed over a radiolucent table in prone position
• After cleaning and preparing the skin, the skin is anesthetized  over the desired facets
• Under fluoroscopy, a small need le is directed into the facet joint.
• A small amount of contrast dye is then injected to confirm that the needle is in the joint.
• After this, small mixture of anesthetic  and steroid then slowly injected into the joint.
• The patient is observed for next half an hour.
• If the joint or joints being targeted are not causing their pain, a patient will not obtain immediate relief from injection.

The patient is instructed to avoid doing any strenuous activities and  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 anesthetic wears off and before the steroid starts to take effect.

Applying ice or a cold pack to the general area of the injection site will typically provide pain relief.

Patients may continue to take their regular pain medicine after the procedure.

The patient may resume previous activities after a day or so.

When the pain relief is substantial, patient may be put on physical therapy.

If the patient has immediate relief with anesthetic, but there is no long term improvement, further tests may be performed.

Risks and Complications of a Facet Joint Injection

• Allergic reaction.
• Bleeding
• Infection
• Site discomfort
• Neural damage