Interarticular Facet Joint Injection

What are interarticular facet joint injections?
An Interarticular facet injection entails the injection of a small amount of medications into the joints in the back of the spine, which gives patients their mobility and reduces pain. It works by reducing the inflammation of the joints that may be due to arthritic changes or tears of the ligaments that hold the joint together.

Am I a candidate for Interarticular facet joint injections?
Facet mediated pain has been implicated as the source of patient’s axial discomfort (located around the midline of the spine) in 20-45% of patients with low back pain, 50% of patients with thoracic pain and 50-70% of patients with cervical pain. When these joints are irritated they not only cause discomfort related to the joint itself, but they also cause the muscles on the sides of the spine to spasm.

What are the benefits of Interarticular facet joint injections?
Facet injections can tell us if the patient’s discomfort is due to arthritis or ligament tears of the joints in the back of the spine. They can also speed the healing process of ligament tears.

How long does an interarticular facet joint injection take?
Approximately 5-20 minutes depending on the number of joints that are treated.

How are interarticular facet joint injections performed?
In most cases, the patient is placed in the prone position on the procedure table (facedown). All patients are monitored with heart rate, blood pressure and an oxygen monitoring device. The skin overlying the treatment area is cleaned with an antiseptic solution and numbed with local anesthetic. The injection needle is then placed under live x-ray (fluoroscopy) guidance into the joint. Once the needle is in the correct position, the medication will be injected. Typically we use a combination of local anesthetic and steroid as the injection medication. The local anesthetic will numb the joint, and if the pain significantly decreases, confirms that the treated joint is an actual pain generator. The steroid provides longer-term relief for the inflammation of the joint and its capsule.

Will the Interarticular facet joint injection hurt?
The procedure involves inserting a needle through skin and deeper tissues which can sometimes be painful. We do numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the spinal needle. Once numbed, placing the spinal needle often feels more like strong pressure and pinching than a sharp pain. Some patients choose to receive intravenous sedation that can make the procedure easier to tolerate. Many patients choose to undergo facet injection without sedation and do well with very little pain throughout the procedure.

What should I expect after an Interarticular facet joint injection?
Immediately after the injection, you may feel like your neck or back is numb. You may notice that your pain may be less immediately following the procedure. This immediate effect is also due to the local anesthetic injected. This will last only for a few hours. Your pain may return and you may have some soreness, worsening pain, or aching for a a few days following. This is due to the mechanical process of the needle insertion, as well as the irritation from the steroid injected. Typically, you should start obtaining pain relief starting the third to fourth day.

What should I do after Interarticular facet joint injections?
With the possibility of numbness or weakness in the extremities due to the local anesthetic, it may make driving following the procedure both difficult and dangerous. All patients must have a ride home prior to undergoing the procedure. Most patients are advised to take it easy for a day or so after the procedure until the medication has a chance to work. Typically you can perform any activity that you were able to perform before the procedure without further limitations.

Can I go back to work the next day?
You should be able to go back to work the next day. Ocassionally, you will feel some soreness or aching at the injection site only.

How long does the effect of the medication last?
The steroid starts working in about three to five days and the effect can last for several days to several months with some cases lasting for several years.

How many Interarticular facet joint injections do I need to have?
if the patient has a good response with the first injection, it may be repeated when the patient’s discomfort returns. If the patient has a good response during the local anesthetic phase, we may suggest a rhizotomy, which can last for 6-18 months.

Will Interarticular facet joint injection help me?
It is sometimes difficult to predict if the injection will help you or not. Patients who have pain in the neck, thoracic or lumbar regions determined to be coming from the facet joints themselves obviously do better. Similarly, patients with a recent onset of pain may respond much better than patients with longstanding pain.

What are the risks of Interarticular facet joint injections?
Generally speaking, facet injections are safe. However, with any procedure there are risks, side effects and possibility of complications. The most common side effect is pain from the actual injection once the local anesthetic wears off and this pain is temporary. The uncommon risks involve spinal puncture, infection, bleeding inside the epidural space, nerve damage and worsening of symptoms. Other uncommon risks are related to the side effects of the long acting steroid such as weight gain, increase in blood sugar in diabetics, water retention and suppression of body’s own natural production of steroids when steroid are overused.

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