The facet joints are the tiny joints situated at the upper and lower part of each vertebra connecting one vertebra to the other. Each of the vertebrae has four facet joints which include a pair that connect to the vertebra above (superior facets) and another pair that connects to the vertebra below (inferior facets). They guide motion and also provide stability. Pain may arise in these joints as a result of an injury to the back, spinal arthritis, or because of increased stress on the backbone. A minimally invasive treatment called facet injection offers symptomatic relief of the back pain caused by inflammation of the facet joints but is not a permanent solution for the condition.
What are the indications for facet joint procedure?
The facet injection procedure may be performed primarily as a diagnostic test to check whether the pain is actually originating from the facet joints. Secondly, it is used to treat inflammation caused by several spine conditions. A facet injection contains a long-acting corticosteroid and an anaesthetic agent which is given either directly into the painful facet joint capsule or into the tissues near the joint capsule. The objective of the treatment is to suppress the pain so that normal activities can be resumed and patients can perform physical therapy exercises.
Facet injection is indicated in conditions where all other conservative treatment modalities such anti-inflammatory medications, rest, back braces and physical therapy have become unsuccessful. Facet injection may reduce inflammation in the facet joints caused by conditions such as spinal stenosis, spondylolysis, sciatica, herniated disc and arthritis. This treatment is not appropriate for patients with an infection, bleeding disorder or during pregnancy. Patients on aspirin or blood thinners will be advised to stop taking them several days prior to the procedure.
How is the procedure performed?
Facet injection is performed as an outpatient procedure, where you can return home on the same day, but make sure you have someone along to drive you home. Usually, the procedure lasts for around 15-30 minutes followed by a short recovery period.
You will be lying face down on a table and be conscious throughout the procedure. Sedatives may be given to make you comfortable and a local anaesthetic is administered to numb the area of injection. Then, your doctor will insert a hollow needle through the skin and muscles into the sensory nerves situated at the facet joints under the guidance of a fluoroscope. Once the position of the needle is confirmed, the medication is injected into your facet joint capsule, following which the needle is withdrawn.
What are the associated risks and complications?
Facet injections are considered as the most appropriate non-surgical means of treatment with minimal risks. The possible risks and complications associated with needle insertion may include bleeding, infection, allergic reaction or occasionally, damage to the nerves. Some of the adverse effects of the corticosteroid medication include weight gain, water retention, flushing and mood swings which usually resolve in 3 days.