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Anatomy of Facet Joints

The facet joints are the tiny joints situated at the upper and lower part of each vertebra, connecting one vertebra to the other. Each vertebra has four facet joints: a pair that connects to the vertebra above (superior facets) and another pair that connects to the vertebra below (inferior facets). They guide motion and provide stability.

Picture of Facet Injections

Disease Overview

Pain may arise in the facet joints because of an injury to the back, spinal arthritis or increased stress on the backbone.

What is a Facet Injection?

A minimally invasive treatment called facet injection offers symptomatic relief from back pain caused by inflammation of the facet joints; however, this is not a permanent solution for the condition. The objective of the treatment is to suppress pain so that normal activities can be resumed and you can perform physical therapy exercises.

Composition of the Facet Injection

A facet injection contains a long-acting corticosteroid and an anesthetic agent administered either directly into the painful facet joint capsule or its neighboring tissues.

Indications of Facet Injections

The facet injection procedure may be performed primarily as a diagnostic test to determine if the pain is originating from the facet joints. Secondly, it is used to treat inflammation caused by several spine conditions.
Facet injection is indicated in conditions where all other conservative treatment modalities such anti-inflammatory medications, rest, back braces and physical therapy have become unsuccessful.

It may reduce inflammation in the facet joints caused by conditions such as:

  • Spinal stenosis
  • Spondylolysis
  • Sciatica
  • Herniated disc
  • Arthritis

This treatment is not appropriate if you have an infection, bleeding disorder or during pregnancy. If you are on aspirin or blood thinners, you will be advised to stop taking them several days prior to the procedure.

Facet Injection Procedure

  • Facet injection is performed as an outpatient procedure where you can return home on the same day, but make sure you have someone with you to drive you home.
  • Usually, the procedure lasts for around 15-30 minutes followed by a short recovery period.
  • You will be lying face down on a table. Sedatives may be administered to keep you comfortable and a local anesthetic administered to numb the area of injection.
  • Then, your doctor will insert a hollow needle through the skin and muscles into the sensory nerves situated at the facet joints under the guidance of a fluoroscope.
  • Once the position of the needle is confirmed, the medication is injected into your facet joint capsule, following which the needle is withdrawn.

Risks and Complications of Facet Injections

Facet injections are considered as the most appropriate non-surgical means of treatment with minimal risks. The possible risks and complications associated with needle insertion may include bleeding, infection, allergic reaction or damage to the nerves. Some of the adverse effects of the corticosteroid medication include weight gain, water retention, flushing and mood swings, which usually resolve in 3 days.