Facet Joint Injections

What is a Facet Joint Injection?
A Facet Joint Injection is an injection of local anesthetic and/or long-lasting steroid (“cortisone”) in the Facet joints – which are located in the back or neck area, as a part of the bony structure.

What is a medial branch block?
The medial branches are nerves which supply the facet joints with sensation. They are small nerves located on top of the bone leading into the joint. Injection of local anesthetic medication around these nerves leads to numbness of the facet joint.

What is a lateral branch block?
The lateral branches are nerves which supply sensation to the sacroiliac joint. They are located along the sacrum, which is the posterior portion of the pelvis, and lead into the sacroiliac joint. Injection of local anesthetic medication around these nerves leads to numbness of the sacroiliac joint.

What is the purpose of it?
The local anesthetic can help to determine the source of back or neck pain. The steroid injected reduces the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain, and other symptoms caused by inflammation / irritation of the joint and surrounding structures.

How long does the injection take?
The actual injection takes only a few minutes, but several joints may be injected at a single setting.

What is actually injected?
The injection may consist of local anesthetic only (such as lidocaine or bupivacaine), or may be combined with steroid medication (such as methylprednisolone – Depo-medrol®).

Will the injection(s) hurt?
The procedure involves inserting a needle through skin and deeper tissues (like a “tetanus shot”). So, there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the needle into the joint or along the spine. Most of the patients also receive intravenous sedative and analgesic medication, which makes the procedure easier to tolerate.

Will I be “put out” for this procedure?
No. This procedure is done under local anesthesia. Most of the patients also receive intravenous sedative and analgesic medication, which makes the procedure easier to tolerate. The amount of sedation given generally depends upon the patient tolerance.

How is the injection performed?
It is done with the patient lying on the stomach or on the side under x-ray control. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin is cleaned with antiseptic solution and then the injection is carried out. After the injection, you are placed on your back or on your side.

What should I expect after the injection?
Immediately after the injection, you may feel that your pain may be gone or reduced. This is due to the local anesthetic injected. This may last for a varying period of time, depending on the medication that was injected. Please keep track of your pain levels for at least 24 hours after the injection, as this information may be necessary to help determine the next step in your treatment. This injection may not provide long-lasting relief, even if the short-term relief is dramatic. You may have some soreness at the injection site(s).

What should I do after the procedure?
You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform the activities as tolerated. Keep track of the level of pain relief experienced after the injection and the length of time you experienced relief.

Can I go to work to work the next day?
Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is a sore back or neck.

How long does the effect of the medication last?
It depends on which medication is injected. Your doctor may not tell you how long to expect relief, because this may be part of the information that determines whether you have responded as expected, or whether it may be a “placebo response.”

How many injections do I need to have?
Your doctor may determine that different medications should be injected at different times, in order to assess that you have had a predicable response to the injections, before proceeding with further treatment, such as Radiofrequency Ablation.

Will the Facet Joint/Medial Branch/Lateral Branch Injection help me?
It is very difficult to predict if the injection will indeed help you or not. It is not expected that you will achieve long-term pain relief with this injection, as it is generally designed as a test procedure to help localize the source of pain. However, if steroid medication (cortisone) is added, often this will lengthen the duration of effect.

What are the risks and side effects?
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain – which is temporary. The other risks involve, infection, bleeding, worsening of symptoms, spinal block, epidural block etc. The other risks are related to the side effects of steroid. These include weight gain, increase in blood sugar (mainly in diabetics), water retention, and suppression of body’s own natural production of cortisol. Fortunately, the serious side effects and complications are uncommon.

Who should not have this injection?
If you are allergic to any of the medications to be injected, you should not have the injection. Your doctor may have you stop blood thinners prior to the procedure. If you have an active infection, your doctor may postpone the procedure until you are better.