Facet Joint Injections
What are Facet Joints?
The spine is made up of a column of 26 bones (vertebrae) sitting one on top of the other. At the top is the skull and at the bottom the pelvis. Between each vertebra and the next are pairs of small joints called facet joints . These allow the spine to move backward and forwards, side to side and to twist. When these joints become inflamed or stiff they can give rise to pain. The facet joints themselves can be made less painful by injection of drugs into them, or alternatively the little nerves that carry the sensation from the joints, called medial branch nerves, can be targeted.
Where is the injection carried out?
You will be asked to attend the Day Surgery Unit for half a day (morning or afternoon) On the day you will be greeted by a nurse who will look after you until you go home. You may be asked to change into a gown and will be taken to one of the operating theatres for the procedure.
How is the injection done?
You will be asked to lie on your front on a special table that allows us to use an X Ray machine to guide the injections. The dose of XRays used is tiny: the machine intensifies a very small XRay dose in a similar way to army night vision goggles. X-ray pictures are taken throughout to ensure the needle is in the correct area.
The skin overlying the joints is sterilised and a small amount of local anaesthetic is injected with a tiny needle to numb the skin. Following this a fine needle is placed either to the joint itself or to the small "medial branch" nerves which supply the joint. Once correct position is confirmed a small amount of local anaesthetic and sometimes steroid is injected into one or more of the affected joints.
The steroid acts only around the area it is injected into and does not have the same effects as taking long-term steroids.
Does it hurt?
You do not need a general anaesthetic for this procedure. Sometimes, on contacting the tender joint, there can be some temporary discomfort: the doctor will ensure pain is kept to a minimum by using local anaesthetic. Once the procedure is over you may have some tenderness over the injection site but no worse than after any other type of injection.
How long will it all take?
Although the procedure itself usually only takes 10-15 minutes you will be asked to stay for up to an hour or so after the injection in the Day Surgery Unit before going home.
You may move around freely at home unless you have been advised to the contrary by a member of staff. Indeed, the patients who do best after this procedure are normally those who make use of the pain relief from the procedure to increase the amount of activity and exercise they do. You do not need to do any specific back exercises unless you have been instructed to do so.
- You may have mild discomfort at the site of the injection; this should last no longer than 48 hours. In a number of patients it can make your symptoms worse for about a week.
- Very rarely you may get a numb leg which lasts for a few hours.
- As for any procedure, we have to warn you that there are very small chances of rare complications such as infection.
- If you have diabetes your blood sugar level can temporarily become less well controlled.
- Very rarely people can be allergic to the injection, which results in redness and itching. This is not serious, but we need to know for future treatments. Very occasionally you may feel some flushing sensations for the first day or two after the injection, as a normal side effect of the steroid.
- Serious complications with this procedure are extremely rare, but if problems arise please consult the Pain Clinic Office, or your own doctor who will contact the Pain Clinic if necessary.
(Please see general comments on the Procedures page)
In some cases, where injection of the facet joints or medial branch nerves gives very substantial but relatively short-lived benefit, it can be appropriate to try to more permanently numb the medial branch nerves. This is discussed in more detail here.
You can download our Pain Service's information sheet on injections for facet join pain from this link.
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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
Page updated 22/6/2016