Each of the spinal vertebral bones has joints connecting them to the other vertebral bones both directly above and directly below. These joints are called the facet joints, and there is a right and left facet joint at each spinal level. Like any other joint, the facet joints may degenerate with time and show signs of arthritis. When this occurs the patient may suffer low back pain and occasionally pain down the back of the legs, usually going no lower than the knees. On occasion, if your pain is not relieved with rest or medicines, your physician may want you to try an injection of steroids and local anesthetic into the affected facet joints in an effort to reduce the swelling and inflammation, and thereby hopefully reduce your pain.
How Is The Procedure Performed?
To do the procedure, the patient lies face down on the bed. The area of the lower back is prepped with a sterile solution to minimize the chance of infection. Then, using an x-ray machine for guidance, the skin overlaying the facet joints in question is anesthetized with local anesthetic. Then a needle is inserted under x-ray guidance until it is on each of the facet joints to be treated. Next, a mixture of steroid and local anesthetic is injected at each facet joint. The patient is then brought back to the recovery area for a short period of observation before being discharged. The procedure usually takes less than 30 minutes. In most cases I will give the patient a sedative to lessen the discomfort of inserting the needle, but as the needle is positioned a pressure sensation or a transient pain similar to your usual symptoms may be experienced as the steroid solution is injected. Additionally, some patients may notice a transient increase in discomfort for a few days after the injection. The number of facet joints injected depends on the particular symptoms of each patient, but varies between one and six with a total of four joints probably being the most common number. After discharge the patient is asked to pay particular attention to how much relief is obtained over the first 4 to 6 hours while the joints are still numb from the local anesthetic. That helps tell me whether the facet joints that were injected are indeed contributing to the patient’s problem. The steroid usually takes up to a few days to start working, and up to 2 weeks for maximal effect. I will call at 2 week’s time to check on the patient’s progress. The injections can be done up to 3 times in a short period of time.
What is the benefit of this injection?
The benefit of facet steroid injections is the potential for the lessening or elimination of your lower back pain. Many of the patients who have an injection report 50% to 75% pain relief, but both the quantity and quality of the pain relief you will obtain are unpredictable in advance. Some patients experience 100% relief while others notice no improvement at all. The duration of your relief is variable as well, ranging from those who note no improvement to those who never have pain again. This injection, however, is a reasonable treatment option for you when conventional treatment such as pain medicines, bed rest, exercises and physical therapy have failed to give relief, and when one would like to avoid surgery, if possible.
Your physician will refer you for an injection and will inform me of your age, presumed diagnosis, and the results of any pertinent tests which have been done, such as MRI or CT scans. Once this information is received I will call you to discuss the procedure with you, and you will receive a separate call from one of our secretaries to schedule your injection if you so desire. Occasionally, you will be scheduled and arrive at the surgery center before I am able to call you. If so, obviously, we will go through your history and the details of the procedure at the surgery center before proceeding. Please be patient if you are not called immediately, but every effort will be made to schedule your injection at the earliest and most convenient time for both of us.
Because you will probably be getting a sedative during the procedure it is preferred that you not eat or drink anything for four hours prior to your injection. Medications, however, should generally be taken as prescribed with small sips of water, though you should let me know if you are on blood thinners such as warfarin, coumadin, Ticlid or Plavix, because often these medications must be stopped for up to a week before the procedure.
What are the potential problems?
As with any medical procedure, facet steroid injections do have the potential for side effects or complications. As already mentioned, you may not obtain any relief or your symptoms may worsen for a few days after the injection. The primary treatment for this is bed rest and pain medicines, but you may always call either myself or your regular physician if you have any concerns. The more serious, but very rare complications include nerve paralysis, infection of the spine, or causing bleeding which could compromise a nerve root. Serious complications such as these are very rare, and probably occur with a frequency no higher than 1 in 6000. When I talk with you we will have a more full discussion of the risks and benefits of this procedure, taking into account your specific medical history.
What should I expect after the injection?
You will be expected to have a ride home following the procedure. Most patients will be able to resume normal activities almost immediately after the injection, but as stated above, some patients may have increased pain following the injection. These patients are advised to rest in a comfortable position for a day or so, and continuation of prescribed pain medicines remains appropriate as needed for post-injection pain.
Follow-up visits to your referring physician after your injection vary. At a minimum, you should call your referring physician 10 to 14 days following your injection to discuss your experience with the block. Since the injection takes a week or two to take maximal effect, I will usually wait until then to follow-up with you by phone.
All of your physicians hope your low back pain will resolve without surgery, and a facet steroid injection is one treatment option that may help you obtain this goal.
Please click on the link below to be redirected to the website spine-health.com to see a video animation of a facet injection