WHAT ARE FACESET JOINTS?
Facet joints, also known as “Z” joints, are located at the back (posterior) of the spine, on each side of the vertebrae where they overlap with neighboring vertebrae. Facet joints provide balance and stability and give the spine the ability to bend and bend. They are made of two surfaces of adjacent vertebrae and are separated by a thin layer of cartilage. The joint is surrounded by a sac-like capsule and filled with synovial fluid (a lubricating fluid that reduces friction between the two bone surfaces when the spine moves and also nourishes the cartilage).
WHY IS FACESET JOINT INJECTION DONE?
Facet joint injection has two causes: diagnosis (to identify the source of pain) and treatment (to treat the detected abnormality).
Most low back pain will improve on its own within a few weeks or with conventional treatments such as rest, anti-inflammatory medications, physical therapy or exercise. If you have been suffering from low back pain for more than six weeks and conventional treatment methods have not helped, your doctor may order diagnostic tests such as magnetic resonance imaging (MRI) or computed tomography (CT) to examine the structures of the spine. A problem with the facet joint (inflammation, irritation, swelling, or arthritis) can cause low back pain. Diagnostic tests may indicate an abnormality in the facet joint, suggesting that the facet joint is the source of the pain. However, sometimes the results may be normal when the source of the pain is the facet joint, on the other hand, abnormal results do not always indicate that the problem is caused by the facet joint.
An injection (sometimes called a “block”) may be given to determine if the source of the low back pain is really a facet joint. If the injection of a small amount of anesthetic or numbing medicine into the facet joint reduces or eliminates pain, this may indicate that the facet joint is the source of the pain. This is the diagnostic use of facet joint injection.
If a facet joint is identified as the source of pain, anesthetic agents and anti-inflammatory drugs may provide pain relief for longer periods of time.
HOW ARE INJECTIONS MADE?
Facet joint injections are performed under local anesthesia while you are awake and able to communicate. Sometimes your healthcare provider may give you medication to make you more comfortable during the procedure. The injection is usually given while you lie on your stomach on the x-ray table. EKG, blood pressure cuffs, and blood-oxygen monitors can be attached before the injection procedure.
Your doctor or an assistant will clean and sterilize the area over the affected joint. During the procedure, you will likely be exposed to fluoroscopic x-rays that allow your doctor to place the needle in the correct facet joint. After careful insertion, your doctor will use a local anesthetic to numb the skin covering the injection site. Before injecting the actual medicine into the joint capsule, your healthcare provider will inject a contrast agent (dye) into the joint to make sure it is the appropriate site for it.
ARE THERE SPECIAL PREPARATIONS?
Once the appropriate site has been identified, your doctor will inject an anesthetic (usually lidocaine or bupivacaine) and an anti-inflammatory (usually a corticosteroid). You will be asked if your pain has gone away, to make sure the injection is done in the right place and to determine if additional injections are needed. This process may be repeated depending on the number of facet joints affected. The entire procedure usually takes between 30 and 60 minutes, although the actual injections only take a few minutes.
If you need an injection into your facet joint, you should not take any nonsteroidal anti-inflammatory drugs (NSAIDs) (aspirin, MotrinTM , AdvilTM, FeldeneTM or similar drugs) starting three days before the procedure. You should also generally not take any pain relievers for at least four hours before the injection. Review all medications with your healthcare professional. On the day of the injection, some healthcare professionals recommend that you do not eat or drink anything, including water, for four hours before the procedure. However, if you are a diabetic using insulin, tell your healthcare professional; You may not need to change your normal eating habits before the procedure. If you need to take medication within four hours of the procedure, a sip of water may be allowed. Review with your healthcare provider regarding food and water restriction prior to injection. For the procedure, you may be asked to remove most of your clothing and wear an apron that opens from the back to access your spine.
WHAT HAPPENS AFTER INJECTION?
Immediately after the procedure, you may feel that your pain is reduced or completely relieved. Your healthcare provider may ask you to perform a movement that normally causes pain to assess the level of pain relief. You will be able to walk immediately after the procedure, although in rare cases some patients may experience leg weakness, numbness or tingling several hours after the injection. It is generally not recommended to drive immediately after an injection, as the drugs can affect your reaction time. It may be necessary to have someone to drive you home after the procedure.
While at home, you can treat any pain you may have at your injection site with ice or medication prescribed by your healthcare professional. It is generally recommended that you ignore this situation and do not force yourself on the first day. After the anesthetic part of the injection wears off over time, your lower back pain may return. It may take seven to ten days for the steroid portion of the injection to begin relieving pain. Usually, after the first day, you can return to your daily activities as much as your pain will allow; however, you should review your situation with your healthcare provider for recommendations on specific activities to allow. In most cases, you can return to work the day after the injection.
If your pain does not subside after the first facet injection for treatment, injection treatments in the same area are generally not recommended.
The efficacy of facet injections in the treatment of low back pain is controversial. There is no medical study that clearly identifies the facet joint as the cause of low back pain. The study found that in 18-63% of patients undergoing the procedure, facet injections were able to relieve lower back pain for more than six months. It is recommended that facet injections be used as a method that allows the patient to perform other traditional forms of treatment (physical exercise, yoga, stretching and bending) rather than as a stand-alone pain relief.
WHO SHOULD NOT HAVE FACESET INJECTION?
Unless you have pain that has lasted for at least four or six weeks and you have not tried other types of conventional therapy, you should not have facet injections for the treatment of your low back pain. If you have a tendency to bleed excessively or take an anticoagulant medicine that prevents blood from clotting, eg. this procedure is not recommended if you are taking coumadin or heparin; You should tell your healthcare professional if you are taking these medicines. If the cause of your low back pain has been diagnosed as an infection or tumor, it may be advisable to use other means of pain relief.
ARE THERE SIDE EFFECTS?
Almost any medical procedure can have side effects and you should always discuss this possibility with your doctor before seeking any treatment. Side effects of facet injections include pain, bleeding, infection, or worsening of pain at the injection site. Side effects of steroid drugs may include fluid retention, weight gain, increased blood pressure, mood swings, and insomnia. These side effects from steroids are usually temporary.
