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Facet Joint Injections
What are they? How are they done?
Zygapophysial joints, better known as facet or “Z” joints, are located on
the back (posterior) of the spine on each side of the vertebrae where it
overlaps the neighboring vertebrae. The facet joints provide stability and
give the spine the ability to bend and twist. They are made up of the two
surfaces of the adjacent vertebrae, which are separated by a thin layer of
cartilage. The joint is surrounded by a sac-like capsule and is filled with
synovial fluid (a lubricating liquid that reduces the friction between the
two bone surfaces when the spine moves and also nourishes the cartilage.)
Indications
Your physician may order diagnostic tests such as magnetic resonance imaging
(MRI) or computerized tomography (CT) scans to look at the structures of the
spine. A problem (such as inflammation, irritation, swelling or arthritis)
in the facet joint may cause low back pain. If these diagnostic tests show
an abnormality in a facet joint, it may be the source of the pain. Physical
exam may also support the diagnosis.
Injections Procedure Overview
The injection is usually performed while you are lying on your stomach under
x-ray imaging. EKG, blood pressure cuffs and blood-oxygen monitoring devices
may be hooked up prior to the injection process.
The procedure is performed using real-time fluoroscopy imaging where your
doctor can see the structures on a TV screen. Your doctor will clean and
sterilize the area of the back directly over the affected joint. Using a
local anesthetic to numb the skin over the injection site, a needle is
inserted into the facet joint. Your doctor will inject the joint with a
contrast (dye) that will show up on the X-ray to ensure she has the proper
site for injecting the medications. Once the proper site has been
determined, your doctor will inject the anesthetic and the steroid.
After The Injection
Immediately following the procedure, you may feel a reduction or complete
relief of your back pain. You probably should have someone who is able to
drive you home following the procedure. Once home, you can treat any pain
you may have at the injection site with ice or a pain medication prescribed
by your doctor. It is generally recommended that you take it easy and not
exert yourself for the first day. After the anesthetic component of the
injection wears off, your back pain may return. It may take 3-5 days for the
steroid to relieve the pain. After the first day, you can usually return to
your daily activities as your pain will allow; however, you should check
with your health care provider to get his or her recommendations on specific
activities that will be allowed. In most cases, you can return to work the
day following the injection.
Effectiveness of Facet Injections
Research has found that facet injections can give relief of lower back pain
for longer than six months in 80% of patients who underwent the procedure.
It has been recommended that facet injections be used as a method to allow
the patient to be able to perform other forms of conservative treatment
(such as physical exercise, yoga and stretching and bending), rather than
using it as a stand-alone pain treatment.
Who Should Not Receive Facet injections?
You should not undergo facet injections for the treatment of low back pain
if your pain has not been present for at least four to six weeks and if
other forms of conservative treatment have not been tried. If you are taking
anticoagulant, it should be stopped for a certain time period allowed by
your doctor.
Side Effects
There is a possibility of side effects with just about any medical procedure
and you should always discuss that possibility with your physician before
undergoing any treatment. Possible side effects from facet injections
include pain at the injection site, bleeding, infection or a worsening of
the pain symptoms. Side effects of the steroid medications used may include
fluid retention, weight gain, elevated blood pressure, mood swings and
insomnia.
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