Facet Joint Injections

What is a Facet Joint Injection?

A facet joint injection involves an interventional pain management technique for facet-related spinal pain¹. The injection includes a small amount of medication such as local anesthetics and steroids into the facet joints to alleviate pain. This acts as a useful pain reliever and reduces inflammation, which often helps a patient to rehabilitate from the injury. This gold-standard technique helps to identify facet joints as a source of pain. This injection also helps to diminish the pain of facet syndrome and supports the patient to tolerate a physical therapy routine.

Usually, a facet joint injection comprises two goals. The first goal helps to diagnose a cause and locates the pain. Another goal includes pain relief. To diagnose the source of pain in the facet joint, you can easily inject numbing medicine like anesthetics into the facet joint. If this results in complete pain relief, then you can confirm the facet joint as a source of pain. Along with local anesthetics, neurosurgeons also inject steroids like cortisone into the facet joint to reduce inflammation. This acts as a long-term pain reliefer. The facet joint injection procedure, also known as ‘Facet Block”, means this block the pain of facet syndrome ².

The symptoms of facet syndrome ranges from a dull ache to chronic pain. This makes us difficult for a person to complete our daily tasks. Other symptoms of facet syndrome include numbness, muscle spasm, burning nerve pain, muscle weakness, stiffness, etc. The anatomy of the facet joint comprises a small paired joint in the neck and back. These joints include an opposing surface of the cartilage and a capsule that fills with synovial fluid. This fluid reduces the friction between two adjacent bones. Facet joints provide stability and help in guiding motion ². These joints can become painful because of arthritis around the spine, back injury, or trauma around the back.

When is a Facet Joint Injection Used?

The major indications of facet joint injection comprise the symptoms of facet syndrome, focal pain over the facet joints, lower back pain supported by radiological findings, post-laminectomy syndrome, and persistent lower back pain after spinal fusion. You may need a facet joint injection if you have multilevel spinal involvement in chronic pain, chronic back (lumbar facets) and neck pain (cervical facets), back pain with or without sciatica, etc. Neurosurgeons generally avoid facet joint injections in people with a skin infection over the puncture site or if you have bleeding disorders or allergy to a specific medication. Studies classified facet joint pain into 3 types: cervical spine pain, thoracic, and lumbar spine pain ³. The prevalence rate of these three comprises 55%, 42%, and 31% among the population of the United States, respectively ⁴. The cost of facet joint injection typically ranges from $1,025 to $1,895 ³.

How is a Facet Joint Injection performed?

Facet joint injection comprises a simple procedure and usually performs in an outpatient surgery unit or an ambulatory surgical center. The injection itself requires a few minutes, but the whole techniques usually take 10 to 20 minutes to perform ². Facet joint injection can easily administer by neurosurgeons and guide by radiologists. Some intern doctors, practice doctors, and rheumatologists can also perform facet joint injections to the patient ⁵.

Facet joint injection usually performs without any sedation. In this injection procedure, the patient will lie on the stomach on the examination table. The nurses will clean the skin over the area. After that, the radiologists will use X-ray guidanceto confirm the position of the facet joint ³. After confirmation, the neurosurgeons will inject a small mixture of anesthetics like lidocaine and anti-inflammatory medications such as steroids slowly into the joint. After the injection, neurologists will apply a small bandage over the injected area.

References

1. Kwak, D., Kwak, S., Lee, A. & Chang, M. Outcome of intra‑articular lumbar facet joint corticosteroid injection according to the severity of facet joint arthritis. Exp. Ther. Med. 4132–4136 (2019) doi:10.3892/etm.2019.8031.
2. Tibrewal, S., Khan, O. H. & Tibrewal, S. B. Facet joint injection in lower back pain – Is its continued use justified? J. R. Soc. Med. 100, 301–302 (2007).
3. Gopinathan, A. & Peh, W. C. G. Image-guided facet joint injection. Biomed. Imaging Interv. J. 7, 12–17 (2011).
4. Schütz, U., Cakir, B., Dreinhöfer, K., Richter, M. & Koepp, H. Diagnostic value of lumbar facet joint injection: A prospective triple cross-over study. PLoS One 6, (2011).
5. Marks, R. C., Houston, T. & Thulbourne, T. Facet joint injection and facet nerve block: a randomised comparison in 86 patients with chronic low back pain. Pain 49, 325–328 (1992).