FACET JOINT INJECTION
Facet joints are small joints of the spine that can
become painful due to arthritis, injury and/or mechanical stress of the
spine. Facet joint injection is performed to isolate and diagnose the
source of pain and to provide therapeutic relief by reducing the
inflammation. Although this type of injection may not provide permanent
relief, it may bring relief for several weeks or months while the cause
of pain is healing. Only one injection may be necessary but sometimes
additional injections may be needed for maximum pain relief. If the
facet joint injection provides good but only short term relief, a facet
nerve injection and radiofrequency rhizotomy procedure may be
recommended.
Before the procedure, blood thinners such as heparin,
warfarin (coumadin), aspirin, and anti-inflammatory medications (except
for celebrex) must be discontinued 5 days prior to the procedure date.
If you are being treated by any specialist, medical clearance may be
needed to proceed. The morning of the procedure, you may have something
to eat or drink but nothing within 2 hours of the procedure.
At the surgical center an IV will be started by a
nurse. When ready you will be taken to the surgical suite where you will
be placed on your stomach for the injection. This sterile procedure is
performed under IV sedation. The area to be injected will be prepped and
anesthetized with lidocaine (local anesthetic). Then under fluoroscopic
(real time x-ray) guidance, small spinal needle(s) will be inserted and
contrast dye injected to confirm the medication is delivered to the
correct location. Then a steroid (anti-inflammatory medication) and lidocaine will be injected into the facet joint(s). During the procedure
your vital signs and oxygen saturation will be continuously monitored.
After the injection, you will be taken to the recovery area and be
evaluated. If your pain goes away after the injection, it is highly
likely the specific joint that has just been injected is the pain
generator. You will be monitored until discharge criteria are met.
You will need a family member or friend drive you
home following the procedure. No exceptions. Following the injection,
the local anesthetic will help stop the pain and the steroid will
prevent its return by reducing the inflammation around the joint(s). You
may also experience some temporary spasms near the injection site. If
this occurs use ice or heat, whichever works best for you. If you are
using ice, place a thin clothe barrier between your skin and the ice
pack. Apply for 20 minutes to the affected area and you may reapply in
60 minutes if needed. If you are applying heat (moist or dry heat) refer
to the manufacturer‘s instructions for application. Never sleep on a
heating pad, burns may occur.
Complications are rare and include but not limited to
bleeding, infection, damage to nerves and structures of the spine,
spinal headaches, perforation of organs, collapsed lung, reaction to
medications, increased pain, seizure, stroke, paralysis, damage to fetus
if pregnant and death. You may be given antibiotics during the
procedure. Your usual pain may be increased for a few days after the
procedure. The risk of injection of steroids include thinning of bones,
pathologic fractures, weakening of ligaments, damage to tissues,
avascular necrosis of the hip, cataracts, decreased immunity, reaction
to medication. Complications are rare. Side effects that occur commonly
include flushing, fluid retention, rash, weight gain, insomnia,
headache. Diabetics will have significant increased in blood sugars for
a few days and will need to monitor their blood sugar levels closely and
adjust medication as directed by their family physician. Sedation is
used for patient comfort and to facilitate performance of the procedure.
Complications of sedation are very rare and include aspiration,
pneumonia, and loss of airway requiring emergency resuscitation or
surgery. The risk of complications requiring transfusion is extremely
low. The risks of transfusion of blood products include transfusion
reaction, infection such as HIV or hepatitis and death.
