Facet injections are a minimally invasive procedure used to relieve pain caused by arthritic changes in facet joints or mechanical low back pain. The procedure involves inserting a needle through the skin and deeper tissues, such as a tetanus vaccine, and into the facet joint. To make the procedure more tolerable, a local anesthetic is used to numb the skin and underlying tissues, and intravenous sedation may be administered. The safest way to perform this procedure is with local anesthesia, so you'll always be awake during the procedure to minimize the chance of nerve damage.
Most patients only feel pressure when the needle is inserted into the joint or along the spine. After the injection, you may feel that the pain has gone away or has decreased due to the local anesthetic injected. This may last for a variable period of time, depending on the medication that was injected. We usually limit the number of steroid injections over a 6-month period to 3 injections.
If you don't get lasting relief after 3 injections, you're unlikely to get long-term relief with a fourth injection. We try to limit the amount of steroids you are given over a 6-month period to reduce the chance of side effects. If you are allergic to corticosteroids, specific local anesthetics, or ionic contrast, tell your doctor.If you are taking an anticoagulant (Coumadin, Plavix, Warfarin, lovenox, aspirin), tell your doctor in advance to help you design a safe plan for the injection. You'll follow up with your doctor two weeks after the injection.
If you still don't feel pain relief, you may be advised to repeat the injection. If you have a partial benefit but still have residual pain, a third injection may be recommended two weeks after the second.Does the injection (s) hurt? Most patients also receive sedatives and pain relievers intravenously, making the procedure easier to tolerate. Immediately after the injection, you may feel that the pain has gone away or has decreased due to the local anesthesia injected. This may last for a variable period of time, depending on the medication that was injected.Keep track of your pain levels for at least 24 hours after the injection, as this information may be needed to help determine the next step in your treatment.
This injection may not provide lasting relief, even if the short-term relief is drastic. You may feel some pain at the injection site.How long does the effect of the medication last? It depends on the medication being injected. Your doctor may not tell you how long you can wait for relief, as this may be part of the information that determines if you have responded as expected or if it is a “placebo response”.Who should not get this injection? If you are allergic to any of the medications you are going to inject, you should not receive the injection. Your doctor may tell you to stop taking blood thinners before the procedure.
If you have an active infection, your doctor may postpone the procedure until you are better.A facet block is an injection of local anesthetic and steroids into a spinal joint. A medial branch block is similar, but the medication is placed outside the joint space, near the nerve that supplies the joint, called the medial branch (a steroid can be used or not). If the facet joint block is effective in relieving pain, it can be repeated up to three times a year.Fluoroscopy or computed tomography (CT) is used to guide placement of a needle in a facet joint. Injecting a local anesthetic around these nerves causes numbness in the sacroiliac joint.
Sometimes contrast material is injected into the joint and placement of needle is confirmed by radiographs or CT scans in real time.Minimally invasive image-guided procedures such as facet joint blockages are usually performed on an outpatient basis by an interventional radiologist. Guided by real-time X-ray images or CT scans, a doctor will insert a needle through skin and into facet joint being treated.Sometimes when facet joint tissue becomes inflamed and irritated they cause pain when bending back. You will be lying face down for lumbar facet joints or on your back for cervical facet joints on an X-ray table.When facet blocks and medial branch blocks are effective in relieving pain they can be repeated up to three times per year with no more than three injections over 6 months period in order to reduce chance of side effects.If you are allergic to corticosteroids, specific local anesthetics or ionic contrast; if you are taking anticoagulants such as Coumadin, Plavix Warfarin lovenox or aspirin; if you have active infection; if you are allergic to any of medications being injected - these conditions should be discussed with your doctor before receiving any injections.The safest way to perform this procedure is with local anesthesia so patient will always be awake during procedure in order to minimize chance of nerve damage. Most patients only feel pressure when needle is inserted into joint or along spine.Immediately after injection patient may feel that pain has gone away or has decreased due to local anesthetic injected and this may last for variable period of time depending on medication being injected.If patient doesn't get lasting relief after 3 injections he/she is unlikely to get long-term relief with fourth injection so it's important to keep track of pain levels for at least 24 hours after injection in order to determine next step in treatment.