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Facet Joint Injection FAQ's
What
is a Facet Joint Injection?
Facet
Joint Injection is an injection of long lasting steroid
("cortisone") in the Facet joints – which are located in the back
area, as a part of the bony structure.
What is the purpose of it?
The steroid injected
reduces the inflammation and/or swelling of tissue in the joint space. This
may in turn reduce pain, and other symptoms caused by inflammation /
irritation of the joint and surrounding structures.
How long does the injection take?
The actual injection
takes only a few minutes.
What is actually injected?
The injection
consists of a mixture of local anesthetic (like lidocaine or bupivacaine)
and the steroid medication (triamcinolone – Aristocort® or
methylprednisolone – Depo-medrol®).
Will the injections hurt?
The procedure
involves inserting a needle through skin and deeper tissues (like a "tetanus
shot"). So, there is some discomfort involved. However, we numb the skin and
deeper tissues with a local anesthetic using a very thin needle prior to
inserting the needle into the joint. Most of the patients also receive
intravenous sedation and analgesia, which makes the procedure easy to
tolerate.
Will I be "put out" for this procedure?
No. This procedure is
done under local anesthesia. Most of the patients also receive intravenous
sedation and analgesia, which makes the procedure easy to tolerate. The
amount of sedation given generally depends upon the patient tolerance.
How is the injection performed?
It is done either
with the patient lying on the stomach, or for the cervical (neck area)
injections – in sitting position, under x-ray control. The patients are
monitored with EKG, blood pressure cuff and blood oxygen-monitoring device.
The skin in the back is cleaned with antiseptic solution and then the
injection is carried out. After the injection, you are placed on your back
or on your side.
What should I expect after the injection?
Immediately after the
injection, you may feel that your pain may be gone or quite less. This is
due to the local anesthetic injected. This will last only for a few hours.
Your pain will return and you may have a "sore back" for a day or two. This
is due to the mechanical process of needle insertion as well as initial
irritation form the steroid itself. You should start noticing pain relief
starting the 5th day or so.
What should I do after the procedure?
You should have a
ride home. We advise the patients to take it easy for a day or so after the
procedure. You may want to apply ice to the affected area. Perform the
activities as tolerated by you.
Can I go to work to work the next day?
Unless there are
complications, you should be able to return to your work the next day. The
most common thing you may feel is sore back.
How long the effect of the medication lasts?
The immediate effect
is usually from the local anesthetic injected. This wears off in a few
hours. The cortisone starts working in about 5 to 7 days and its effect can
last for several days to a few months.
How many injections do I need to have?
If the first
injection does not relieve your symptoms in about a week to two weeks, you
may be recommended to have one more injection. If you respond to the
injections and still have residual pain, you may be recommended for a third
injection.
Can I
have more than three injections?
In a
six-month period, we generally do not perform more than three
injections. This is because the medication injected lasts for
about six months. If three injections have not helped you much,
it is very unlikely that you will get any further benefit from
more injections. Also, giving more injections will increase the
likelihood of side effects from cortisone.
Will
the Facet Joint Injection help me?
It is
very difficult to predict if the injection will indeed help you
or not. Generally speaking, the patients who have recent onset of
pain may respond much better than the ones with long standing
pain.
What
are the risks and side effects?
Generally
speaking, this procedure is safe. However, with any procedure
there are risks, side effects, and possibility of complications.
The most common side effect is pain – which is temporary. The
other risks involve, infection, bleeding, worsening of symptoms,
spinal block, Epidural block etc. The other risks are related to
the side effects of cortisone: These include weight gain,
increase in blood sugar (mainly in diabetics), water retention,
suppression of body’s own natural production of cortisone etc.
Fortunately, the serious side effects and complications are
uncommon.
Who
should not have this injection?
If you
are allergic to any of the medications to be injected, if you are
on a blood thinning medication (e.g. Coumadin®), or if
you have an active infection going on, you should not have the
injection.
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