Facet Joint and Spinal Arthritis Injections

What is a Facet Joint Injection?
The facet joints are small joints that are on the back part of the spine. These are the same type of joint as the shoulder or knee. All joints can be helped by injecting various medications into the joint.

What is the Purpose of a Facet Joint Injection?
Facet joints can become arthritic. Usually, there is an inflammatory and a degenerative component. Anti-inflammatory medications and medications to help restore the joints can be injected.

Am I a Candidate for Facet Joint Injection?
Anyone with neck or back pain from their facet joints is a candidate. You can have facet joint pain with or without changes on your x-ray or other tests. There is no way to tell if the pain is coming from the facet joints without doing some type of injection. Usually, but not always, facet joint pain is made worse by standing and walking, and it affects the back or neck more than the arms or legs.

How is the Procedure Performed?
The patient lies face down on the procedure table. X-ray equipment (fluoroscopy) is always used. The site to be injected is numbed with local anesthetic (Novocain) and a needle is directed to the target area. Contrast (x-ray dye) is injected to be sure the needle is in the proper position, and the medication is slowly injected.

Will the Procedure be Painful?
There is a certain amount of discomfort involved with this procedure. Most of the pain occurs when the skin and underlying tissues are numbed. The smallest sized needle that will accomplish the procedure is always used. A pressure sensation is common when the medication is injected. You may have sedation administered for this procedure, but many people do it under local anesthetic.

What are the Risks and Side Effects?
Complications for this procedure are low. Whenever a needle enters the skin, bleeding or infection can occur. If steroid medication (synthetic cortisone) is used, there may be some side effects from the medication. Side effects from the steroid medication include flushing, insomnia, increased heart rate, some swelling, and a rise in blood sugar and occasionally blood pressure. These side effects are usually mild and temporary, but a rare patient may find the “steroid effect” quite unpleasant. If you are diabetic or have unstable blood pressure, clearance from your primary care physician should be obtained before the procedure. At a minimum, you should monitor your blood pressure and/or blood sugar carefully until you are sure they are back to normal levels. If steroid use is a problem, steroids may be avoided by using non-steroid medications instead.

You may have an allergic reaction to any of the medications used. If you have a known allergy to any medication, especially x-ray contrast dye or local anesthetics, notify our staff before the procedure takes place. The most serious side effects from intravenous sedation are sudden death, brain damage from low blood pressure, or allergy from the medication. These are extremely rare and have never happened in my practice. A nurse will be monitoring your blood pressure, blood oxygen level, and heart rate. If necessary, oxygen will be administered through a tube inserted in your nose.

More serious but extremely rare risks include nerve injury, paralysis, weakness, or death. These complications have never occurred in our practice.

How Long Does it Take for the Procedure to Work?

You should feel some relief the same day as the procedure since there is local anesthetic (Novocain) in the medication injected. It is important for you to record how much relief you get the same day as the procedure.

What Restrictions Will I Have on the Day of the Procedure?
If you have been given sedation, you will not be allowed to drive, operate machinery, or make legal decisions until the next day. There are no other restrictions. You are encouraged to “test” the procedure by doing activities that would otherwise be painful (and keeping a record of your pain ratings). You should not soak until the skin is healed. You may shower the same day.