What is a facet joint injection?

Vertebrae have paired joints in the back and the neck, with one pair at each vertebral level. These facet joints have cartilage on their contact surfaces, and a capsule that contains a lubricating fluid (synovial fluid) surrounds each joint. These joints provide stability to the spine and allow movements like bending and twisting.

Some conditions may cause nerve pain (sciatica) due to persistent irritation and inflammation of the nerves located near the facet joints. Facet joint injections relieve pain and other symptoms by injecting powerful anti-inflammatory drugs (corticosteroids) and/or local anesthetics directly next to the affected area. This therapy has been shown to be effective in relieving symptoms of pain.

What are the indications for a facet joint injection?

Facet joint injections are done for two purposes, namely:

  1. Diagnosis – to determine the source of the pain
  2. Therapy – to relieve pain and other symptoms

This therapy is usually recommended when more conservative treatments, such as oral anti-inflammatory and analgesic medications, have failed. Facet joint injections have been proven to be of use in conditions such as:

How is the facet joint injection procedure done?

The procedure normally takes anywhere from 15 to 30 minutes, depending on the
number of joints involved, the experience of the surgeon, among other factors. This is normally done under local anesthesia, although you may be given a mild sedative to help you relax. Your vital signs will be monitored throughout the entire procedure.

The surgical site will be prepped with antiseptic solution, and the surrounding area will be draped with sterile linen.

The surgeon will then insert the needle through the skin and muscle, under fluoroscopic (X-ray) guidance. In recent years, other techniques of guiding the needle have emerged, such as through Magnetic Resonance Imaging (MRI) imaging or ultrasonography.

When the end of the needle is near the affected facet joint, a local anesthetic is applied, and the needle is withdrawn. You may be asked to rest in that position for several minutes before being asked to do movements that normally trigger pain. If there is good response (i.e., less or no pain with movement), then the needle is re-inserted to allow injection of anti-inflammatory medications such as corticosteroids. These medications will allow for longer lasting relief from the symptoms.

How successful are facet joint injections?

There are varied reports of the success rates of facet joint injections, but most patients will respond favorably to treatment. Facet joint injection has been shown to relieve up to 83% of patients with symptoms of radiculopathy (nerve pain), and at least 50% of patients will experience relief from pain that can last for several months.

While facet joint injections are relatively safe, you should always be aware of the risks that accompany the procedures. These can include infection, intraoperative damage to nerves, muscles, and soft tissues, and vasovagal complications.

Bleeding and pain at the operative site is also noted, but this can usually be easily managed. However, these have been noted to have low occurrence rates, and you can avoid adverse outcomes by choosing an experienced surgeon and a properly licensed hospital.

References

Ribeiro LH, Furtado RN, Konai MS, Andreo AB, Rosenfeld A, Natour J. Effect of facet joint injection versus systemic steroids in low back pain: a randomized controlled trial. Spine (Phila Pa 1976). 2013;38(23):1995-2002. doi: 10.1097/BRS.0b013e3182a76df1.

Manchikanti L, Pampati V, Singh V, Falco FJ. Assessment of the escalating growth of facet joint interventions in the medicare population in the United States from 2000 to 2011. Pain Physician. 2013;16(4):E365-78.

Hwang SY, Lee JW, Lee GY, Kang HS. Lumbar facet joint injection: feasibility as an alternative method in high-risk patients. Eur Radiol. 2013;23(11):3153-60. doi: 10.1007/s00330-013-2921-z.

Park KD, Jee H, Nam HS, Cho SK, Kim HS, Park Y, Lim OK. Effect of medial branch block in chronic facet joint pain for osteoporotic compression fracture: one year retrospective study. Ann Rehabil Med. 2013;37(2):191-201. doi: 10.5535/arm.2013.37.2.191.