What is a facet joint?
The vertebral bodies are stacked one on top of another to form the entire structure we call the spine. In between vertebral bodies are tiny joints called facet joints. As arthritic change and inflammation of the joints occur, the nerves to the facet joints can convey severe and diffuse pain. The pain does not follow a nerve root pattern. It is actually called ‘referred pain’, as the brain has trouble localizing these internal structures. Patients often complain of pain in a generalized poorly defined region of the neck or back. There may be some tenderness overlying the involved joints as well.
It is usually caused by trauma (auto accidents, whiplash, a bad fall) or a degenerated or herniated disc. These all cause the spine to sub-lux (move out of joint) and the joint capsule is irritated. It is usually worsened by sudden movements or prolonged episodes of poor posture, (e.g. kneeling in the garden, bending over to lift or straining to read a book or a computer terminal). Many patients find the worst time is at night, when all the muscles relax and the joints grind together. It can be mistaken for a condition called fibromyalgia or for myo-fascial syndrome. Oftentimes there is an associated SPASM of the muscles in the paraspinal region [on either side of the spine], which can further confuse diagnosis.
Diagnostic Facet Injections: Placing local anesthetic and steroid medication directly into the facet joint can ‘block’ facet joint pain. Since the nerve root can supply two levels of facets, it is recommended that the joint space above and below are injected with medications.
Using a small needle and an X-ray machine (Fluoroscopy), medication is placed with X-ray guidance into the facet joints. In most cases, one side is selected first to help diagnose and therapeutically treat the current back pain complaints. While an injection may last on average of four months, patients can experience many different results. It is recommended that injections be performed every four months.
Complications: As with any injection, infection, bleeding, increased pain, and failure to derive expected results may occur. The risk for these problems is lowered due to the use of a sterile environment in the operating room and discontinuation of Aspirin, Coumadin, or nonsteroidal anti-inflammatory drugs.
Procedure: Your doctor will place you on your stomach in the operating room and clean your back where the needles will be placed. Local anesthetic is used to prepare the skin and prevent excessive pain. You will feel pressure due to the placement of the needles. A fluoroscopy X-ray machine guides the needle and pictures are taken when a ‘beeping’ sound is made. You doctor will then ask you if your current pain is reproduced when medication is placed into the facet joint. This may be painful, but it does give excellent information to your doctor. Once the medication is placed you will be returned to the recovery room. You may experience some pain after the injection. This is normal and is likely this due to the irritation of the needle into your muscle. Ice placed over the injection site for 20 minutes 2-3 times for the next two days will help. If you continue to have pain, please contact the office for further management.