Facet Joint Injections

Cervical, Thoracic, and Lumbar Facet Joint Injections

Facet joints are small joints at each segment of the spine that provide stability and help guide motion. The facet joints can become painful due to arthritis of the spine, a back injury, or mechanical stress to the back.

A cervical, thoracic or lumbar facet joint injection involves injecting a small amount of local anesthetic (a numbing agent) and/or steroid medication, which can anesthetize the facet joints and block the pain. The pain relief from a facet joint injection is intended to help a patient better tolerate a physical therapy routine to rehabilitate his or her injury or back condition.

Facet joint injections usually have two goals: to help diagnose the cause and location of pain and also to provide pain relief:

Diagnostic goals: By placing numbing medicine into the facet joint, the amount of immediate pain relief experienced by the patient will help determine if the facet joint is a source of pain. If complete pain relief is achieved while the facet joint is numb, it means that joint is likely a source of pain.
Pain relief goals: Along with the numbing medication, a facet joint injection also includes injecting time-release steroid (cortisone) into the facet joint to reduce inflammation, which can sometimes provide longer-term pain relief.

The Facet Injection

The injection procedure includes the following steps:

Commonly, the procedure is performed without any sedation, however, an IV line can be started if relaxation medicine is needed.
The patient lies on a procedure table, and the skin over the area to be tested is well cleansed.
The physician treats a small area of skin with numbing medicine (anesthetic), which may sting for a few seconds.
The physician uses X-ray guidance (fluoroscopy) to direct a very small needle into the facet joint.
A small amount of contrast dye is then injected to confirm that the needle is in the joint and that medication is contained inside the joint.
Following this confirmation, a small mixture of anesthetic (such as lidocaine) and anti-inflammatory medication (steroid/cortisone) is then slowly injected into the joint.

The injection itself only takes a few minutes, but the entire procedure usually takes between fifteen and thirty minutes.

Immediately Following the Injection:

After the procedure, the patient typically remains resting in the recovery area for twenty to thirty minutes and then is asked to perform some movements or activities that would usually provoke their pain.
Patients may or may not obtain pain relief in the first few hours after the injection, depending upon whether or not the joints targeted are the main source of their pain. If the joint or joints being targeted are not causing their pain, a patient will not obtain immediate relief from injection.
On occasion, patients may feel numb or have a slightly weak or odd feeling in their neck or back for a few hours after the injection.
The patient will discuss with the doctor any immediate pain relief, and any questions or concerns.

When the pain is improved, it is advisable to start regular exercise and activities in moderation. Even if pain relief is significant, it is still important to increase activities gradually over one to two weeks to avoid the recurrence of pain.