Facet Injections Q&A

Facet joints are small, bony joints at each segment of the spine’s vertebrae that provide stability and help to guide motion. The facet joints can become painful due to arthritis of the spine, a back injury or stress to the back. The thoracic facet injection is performed to reduce mid back pain. The facet injections can help localize the pain, improve flexibility, enhance function, and in general help patients return to their normal life.

What are facet injections?

A facet injection, also known as a medial branch block, is designed to identify the source of spinal pain. There are many components to the spine that could be injured and causing pain. One of the most common causes of pain is facet joints. This treatment's goal is to determine if the patient's pain is from arthritic facet joints. A facet injection is a diagnostic tool; pain relief may vary from minimal to complete elimination of pain. This relief may only last a few hours. The purpose of this procedure is not to provide long lasting pain relief, but to identify if arthritic facet joints are the source of a patient’s pain.

How do facet injections work?

Facet arthritis means the joints of the spine are inflamed. Nerves in the spinal cord transmit pain impulses when this occurs. A facet injection will block these impulses, thus reducing pain. Medications used during this procedure may include local anesthetics and an anti-inflammatory drug. These drugs and this procedure have a long record of safety and effectiveness, although there are always a minority of patients who respond poorly to such treatment.

During a cervical or thoracic facet joint injection procedure, the process involves:

• You will lie face down, with two pillows underneath your chest
• The skin over the back of the neck (for cervical) or mid-back (for thoracic) will be cleaned and numbed
• Using fluoroscopic (X-ray) guidance, your physician will identify the facet joints that should be injected.
• A thin needle into the back section of the facet joint.
• Next, the doctor will inject a small amount of contrast dye to make sure that the medication will flow exactly where it needs to be administered
• The physician will inject a small amount of steroid solution.
• After the procedure, you’ll spend 20 to 30 minutes in the recovery area.
  

The steroid usually starts to work two days to two weeks after the injection. The pain relief varies for each individual, from no relief to long-term pain relief. Patients can have up to four steroid injections per year, depending on their other health problems or steroid injections into different areas of the body.

What are the advantages of facet injections?

Facet joint injections act as a non-invasive tool to confirm the facet joint is, in fact, the source behind a patient’s lumbar pain. Combined with physical therapy and medication, this treatment option can reduce inflammation, which in turn, can improve an individual’s function and overall quality of life without the need for invasive back surgery. Studies have found facet-joint injections to have immediate, long-lasting low-back pain relief. A facet joint block offers patients two potential benefits: to reduce inflammation and pain in a facet joint or joints and to provide diagnostic information about the cause, location and/or pain source.

The facet injections are usually offered as a last resort when all else fails, they may be used for conditions where the joints become susceptible for pain, such as:

• Lumbar facet syndrome
• Spondylolysis
• Spinal Stenosis
• Spondylolisthesis
• Ankylosing Spondylitis
• Trauma such as car accidents or sports/work involving “repetitive forceful hyperextensions”
  

While a facet block may quickly reduce pain, relief is not permanent and a repeat block may be recommended depending on the outcome of the first. Facet blocks are usually performed to help manage chronic neck or back pain. Because a facet joint block may include a steroid (corticosteroid), the number of injections is limited to help prevent and minimize steroid-related side effects such as loss of bone density.