Lumbar Facet Joint Injection for Back Pain

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.

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.

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

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-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.

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.

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.

Most experts recommend not more than 3 injection 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.

This is rare but there is an increased risk in skin conditions like psoriasis or eczema.

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.

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

In people with diabetes or at risk of diabetes, their blood sugar is found to rise immediately after the caudal epidural injection. This will settle after a few days without treatment.

Facet joint steroid injections are simple, non-invasive, safe procedure that provides instant relief from neck pain and stiffness. However the results vary between patients and last anywhere between six weeks to 6 months. It is the physiotherapy exercise program that gives the maximum benefit from this injections.

These steroid injections just provide the pain relief necessary for the physiotherapy program to improve the movement and function of the facet joints. Therefore the success of the facet joint steroid injection depends on the physiotherapy program that follows after the injection.

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 injection. There are no limitations for work if your pain settles after a day.

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 facet joint injection. There are no limitations for work if your back pain settles after a day.

The actual procedure of a lumbar facet joint injection is not painful as it is done under sedation and it takes just 10 minutes for the actual procedure to be done. You will wake up with no pain and will be sent home with medications to control any pain after the local anaesthetic wears off.

Avoid driving for at least 12 hours after the procedure. You may suffer from dizziness or sickness as you may not have fully recovered from the sedation.  It is common to experience mild soreness at the site of the steroid injections for 24–48 hours.

Your neck may feel stiff and sudden movements or jerks can cause severe pain. So, driving may be a risk if done early.

The effect of facet joint steroid injection lasts between 6 weeks to 6 months. There is an instant pain relief from the local anaesthetic which lasts for a few hours. The cortisone (steroid) starts to work in 24 to 48 hours and last for a good few months.

In some patients they seem to last for ever. Some need a few more injections for good relief from facet joint pain.

Facet joint steroid injections are successful on most occasions. However in some instances, you may need up to 2 or three sets of these injections. If this treatment with facet joint steroid injections are unsuccessful, radiofrequency ablation will be recommended.

Radiofrequency ablation is a procedure where radio waves are used to generate heat to burn off the tiny nerves that supply the facet joints. By burning of these nerves, the pain sensation from these joints can be blocked and this can lead to permanent freedom from pain.

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.