Facet Joint Injections

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Manx Pain Clinic

Facet Joint Injections

Why do I need this injection ?

_ Your doctor thinks that you have back or neck pain caused by inflammation of the spinal facet joints. These joints can cause spinal pain and also referred pain to the arms or legs.

_ Facet joint inflammation can show up on MRI and Bone scans.

_ There is usually muscle spasm in the area of the joint close to the centre of the spine on examination. The combination of muscle spasm and joint pain can make movements in the neck and back stiff and painful.

What is a facet joint injection and how does it work ?

_ The aim of a facet joint injection is to get a small amount of local anaesthetic and triamcinolone inside the joint using a fine needle.

_ This produces an anti-inflammatory effect inside the joint, reducing pain.

_ There may be also a reduction in the painful muscle spasm around the joint through dorsal horn

mechanisms in the spine.
How long will the pain relief last for ?

_ It is not possible to answer this question on an individual basis.

_ Pain relief can be as follows:-

_ The injection eliminates the pain never to return again

_ The injection reduces the pain for several weeks, the pain returning but not as bad.

_ The injection reduces the pain for several weeks, but it returns as bad as ever afterwards.

_ Facet joint injections can be used in two ways:-

1. As a diagnostic tool to confirm whether the facet joints are the cause of the pain, and in particular which joint is the main culprit. If the diagnosis is confirmed many people choose to go on to Facet Joint Denervation as the next step.

2. As a treatment for back pain repeated intermittently.

How is the injection performed ?

_ Lumbar facet joint injections are performed lying face down, whilst cervical facet joint injections are done either lying on one side, or lying on your back.

_ The area to be injected is cleaned with anti-septic solution, and the skin in the area numbed with some local anaesthetic - this stings a little at first.

_ Using x-ray guidance, a fine needle is inserted into the cente of each facet joint ot be injected. A small amount of local anaesthetic and depot steroid triamcinolone is then injected.

Question Answer

What happens after the injection ?

_ You will normally be able to get up off the x-ray table by yourself and walk unaided.

_ Pain relief may occur in the following ways:-

_ Immediate relief which lasts for several weeks.

_ Worse for a while, and then relief which lasts for several weeks.

_ No change for several days, and then slowly improves for several weeks.

What are the side effects of the treatment ?

_ Temporary numbness in the legs - only occurs if the local anaesthetic is injected too close to the spinal nerve roots.

What are the risks and complications of the treatment ?

_ Local soreness / bruising at the injection site - usually settles in a few days.

_ No pain relief - the commonest complication would be that the treatment did not help the back pain. The causes of this include incorrect placement of the needle, and wrong diagnosis i.e. the back pain had some other cause.

_ Worse Pain - like any other treatment, the pain can be worse afterwards rather than better. The

commonest reason for this is increased muscle spasm in the area of the injection. The needle has to pass through some of the spinal muscles to get to the joints. These occasionally react by going in to spasm, but in most cases this resolves spontaneously.

_ Infection - introduction of infection can cause a facet joint or paraspinal abscess. Infection can be minimised by performing the procedure under sterile conditions. Sometimes infection can spread through the blood to the paraspinal area / facet joints from other distant sites. The injection should therefore not be done when there is overt infection elsewhere in the body. Diabetics are more prone to staphylococcal infections generally.

_ Anaphylaxis - severe allergic reaction to the components in the injection mixture - more common to local anaesthetics but rare with lignocaine. Please tell your consultant before the treatment about all of your drug allergies.
Should you have any further questions, then please discuss them with your consultant prior to starting the treatment.

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