Facet joint Injection for Back pain

What is Facet joint injection for back pain?

Facet joint injection is a small procedure that is very useful to control low back pain performed under intravenous sedation. This is a mixture of local anesthetic and steroid used to reduce the pain and inflammation around the small joints in your back called the facet joint. This pain and inflammation is due to the ‘wear and tear changes’ in your spine. These joints get loaded excessively due to the loss of cushioning effects of the discs between the bones of your spine. This is called ‘facet joint arthritis’ or ‘facet arthropathy’. This may be associated with ‘Spinal Stenosis’.

When is this procedure recommended?

Facet joint injection is recommended for control of your low back pain. Inflammation caused by the wear and tear of your spine produces chemicals around your small joints of your spine called the ‘facet joint’. This is the main cause of low back pain in the middle aged and elderly. There are other causes of low back pain.

Where is Facet joint injection given for my back pain?

Facet joint injection is given to the ‘facet joint’ that links the block of bones in your spine called ‘vertebrae’. As we know that our lower lumbar spinal column is made of 5 bones (vertebrae) and the soft cushion (disc) between these bones. These discs act as both a spacer and a shock absorber. The bony spine and discs are surrounded by muscles (core muscles).  The bones (vertebrae) of your spine has a pair of interlocking and moving connections called facet joints.

These facet joints slide over each other that help us bend and twist. Both joint surfaces of each facet joint is coated with a moist cushioning tissue (cartilage). A small covering (capsule) surrounds each facet joint and provides a lubricant for the facet joint. The covering (capsule) contains nerve fibres that give warning by causing pain when there is irritation or inflammation of the facet joint.

What does a Facet joint injection contain?

Facet Joint injection contains a mixture of:

      • Kenalog 40 mgs (Steroid)
      • Marcaine 0.25% (Local anaesthetic)
Facet Joint injections of the neck - Kenalog is the Steroid used. Mangattil Rajesh - Spine Surgeon London

Kenalog is a Steroid commonly used in Facet joint Injections. This steroid works on the small joints of your spine called ‘facet joints’ and reduces pain and inflammation around them.

It blocks the chemicals that your body releases with the inflammation around the facet joints due to arthritis. Due to the pain relief, there is more movement in the small (facet) joints and the soft tissues.

This increase in movement will further reduce the stiffness around the bones, ligaments and muscles of your spine.

Facet Joint injections of the neck. Marcaine is the local Anaesthetic used. Mangattil Rajesh - Spine Surgeon London

Marcaine 0.25% is a local anaesthetic (numbing solution) used by your dentist. This is also used in Facet joint Injections. This solution works on the small joints of your spine called ‘facet joints’ and reduces pain and works very well with the steroid.

It blocks the pain signals released by your irritated and inflamed facet joints and the steroid works to control the inflammation. Due to the pain relief, there is more movement in the small (facet) joints and the soft tissues.

This increase in movement will further reduce the stiffness around the bones, ligaments and muscles of your spine.

What does a Facet joint injection exactly do?

Facet joint injection contains a mixture of numbing solution (local anaesthetic) and corticosteroid (steroid). The local anaesthetic will improve the pain immediately and the steroid in the solution will act on the inflammation around the covering (capsule) of the facet joints and control the pain in the long term. This improvement in the pain will help you move around better and mobilise your lower back. This increase in the movement of the small joints of your spine will further reduce the stiffness around the bones, ligaments and muscles.

What happens during the facet joint injection procedure?

Sedation during a Day procedure for facet joint injection Spine Surgeon Mangattil Rajesh

DAY CASE PROCEDURE

This procedure is done as a Day Surgery procedure. You will need to come in starved for at least 6 hours and will be at the hospital for less than a day.

You will be given a sedative by the anaesthetist so that you do not feel the pain or the procedure.

The facet joint steroid injection procedure takes less than 10 minutes and is very safe.

X-ray used for Facet joint steroid injections - Mangattil Rajesh Spine Surgeon London

X-rays will be taken (shown in picture) to make sure that the needle placement is accurate. The dye (Omnipaque 300) is not used before the anaesthetic and steroid solution is injected. You will recover from the procedure and sedation very quickly.

A spinal needle is used to inject the steroid and anaesthetic solution in and around the ‘facet joint’.

After the injection, you will be taken to the recovery room from theatre and monitored for an hour. You will be able to leave hospital once you are safe.

What happens after the Facet joint injection?

Home after day Case procedure. Mangattil Rajesh Spine Surgeon London

After the injection, you will be taken to the recovery room from theatre and monitored for an hour.

You will be able to leave hospital once you are safe.

You must continue to take your usual pain relief medication that your doctor had prescribed for you till you begin to feel benefit.

Some medications like morphine, gabapentin, pregabalin or amitriptyline need to be continued and not stopped abruptly.

What are the benefits of this procedure?

80% of patients will have significant benefits from these facet joint injections. But the duration of this pain control varies between a few weeks to a few months. Sometimes the pain relief can last for a year. For most part, these facet joint injections can provide excellent pain relief enabling you to continue with physiotherapy rehabilitation, keep yourself active and possibly lose weight if necessary. Occasionally, you run the risk of getting the pain back sooner than expected.

Repeat Injections: If the initial facet joint injection was helpful in controlling your back pain, you will be offered a repeat injection. Most specialists would wait at least six months before repeating them.

Pain Clinic: If the symptoms have not improved after six weeks or the pain relief only temporary or short lived, the next stage in the treatment would be to refer you to a Pain Clinic for further assessment or treatment.

How many Facet joint injections can you have?

Most experts recommend not more than 3 injections over a 12-month period. There are concerns about the adverse side effects of repeated steroid injections on your spinal cord, nervous system function and on your metabolism. There is a very small risk of diabetes, raised blood pressure, decreased immunity, recurrent infections and weight gain.

What are the risks and complications of Facet joint injections?

INFECTION: This is rare but there is an increased risk in skin conditions like psoriasis or eczema. The rate is less than 1 in 1000 injections

BLEEDING: There is very little chance that you will bleed from a tiny puncture wound with a needle. But there is an increased risk of bleeding if you are taking medications to ‘thin your blood’ like warfarin, rivaroxaban or clopidogrel. You will be advised to stop these medications at least a week in advance of the procedure for safety.

FASCIAL FLUSHING: This is a temporary side effect from the steroid injection and settles down very quickly.

VASOVAGAL OR FAINTING EPISODE: This can be due to the stress of the procedure and is not life threatening. 1 in 100 patients do have such episodes and it settles very quickly.

When can I get back to work after Facet joint injections?

You are advised to take the next day off work as you had an intravenous sedation. If your back pain persists or is worse, you may need a few days off work. Usually, it can take several weeks before you feel the full benefit of the caudal epidural injection. There are no limitations for work if your pain settles after a day.

When is my follow up appointment?

This is booked in 4 weeks after the injection. It allows you to explain the progress of you lower back pain to Mr Rajesh and he may arrange physiotherapy to build on the gains from the injection. Repeat injections or possible the need for surgery only if necessary, can be discussed.

Mr Rajesh’s Advice:

Make sure that you take all the precautions and advice given here. If your symptoms have not improved after 6 weeks or of the pain relief was only temporary, you may need a repeat injection or surgery to take the pressure off the affected nerve roots.

Here at Spine Surgeon, we have both Online and Direct Consultations. If you wish to avail a consultation:

  • WhatsApp or text him on: +447956 381 383
  • Write to him directly: rajesh@spinesurgeon.london

Leave a Reply

Your email address will not be published. Required fields are marked *