Cervical Facet Joint Injections

Introduction

A common source of neck, mid back, and low back pain, is arthritis of the facet joints. These are small synovial joints (like other joints in the body) that allow for movement of the neck and back. When arthritis becomes significant enough to involve these small joints, simple movements such as bending, twisting, standing, or walking can create significant pain. This pain is transmitted to the brain by way of a small nerve from each joint, called the medial branch nerve.

Facet joint injections are a safe, non-surgical, minimally invasive treatment for pain coming from arthritis or inflammation of the facet joints.

Goal of the injection

The goal of a facet joint injection is to place a small amount of steroid (cortisone or corticosteroid) and local anesthetic into one or more of the inflamed joint(s). The injection can be used to diagnose or treat. The injected steroid serves as an anti-inflammatory medication, decreasing pain and improving the patient’s movement and activity.

Sometimes facet injections are used specifically to help diagnose where the pain may be coming from, and can help determine if a patient would be a candidate for other treatments used to decrease painful conditions of the facet joints, such as radiofrequency ablation.

The procedure

The patient is brought into a sterile procedure suite, and asked to lie on the exam table. Using X-ray guidance, the skin is anesthetized and a small needle is directed to the joint(s) of interest. Once the needle is in proper location, a small amount of steroid medication is injected.

Following injection, the patient is cared for in the recovery area for a brief amount of time, and then discharged home.

After the procedure

Follow the specific instructions given to you by the nurses at the time of discharge from the recovery area:

• Resume activity as tolerated
• Patients may be encouraged to perform activities that typically cause an increase in their normal pain. This is used to “test” whether the diagnostic procedure is helpful in reducing your pain.
• Do NOT soak in a bathtub or lake for 24 hours after the procedure. You may shower.
• You will receive a phone call from a clinic nurse, asking about the relief of symptoms you experienced after your injection.

If your procedure includes sedation

• You should have no solid foods for 8 hours before the procedure.
• You may have clear liquids up to 2 hours before your procedure. Examples of these clear liquids are:  water, broth, clear juices with NO pulp, tea, coffee WITHOUT cream. Carbonated beverages are NOT allowed.
• No gum chewing for 2 hours before your procedure.
• No candy, throat lozenges, or mints.
• A nurse will call you before your procedure to review your medications and make recommendations as to what medicines you should take before your procedure.

Failure to comply with these instructions may result in cancellation and rescheduling of your procedure.

Potential risk of the procedure

Facet joint injections are considered safe, non-surgical, minimally invasive treatments. As with all medical procedures, there associated risks and side-effects that may vary between each patient. These rare but potential risks are:

• Pain at the injection site
• In very rare instances (less than 1%), minor infections can occur
• Increased pain or worsening symptoms.
• Collapsed lung (Pneumothorax). This is a unique risk to thoracic facet joint injections because of the proximity of the lung in that region of the body.
• Bleeding. The patient may suffer bleeding from undergoing procedures, especially while on blood thinning medications. Please notify us if you are taking any of the following blood thinning medications: Warfarin (Coumadin), Plavix (Clopidogrel), Aspirin, Xarelto (Rivaroxaban), Heparin, Lovenox (Enoxaparin), Brilinta (Ticagrelor), or any others not listed.
• Nerve or spinal cord damage. In extremely rare instances, a patient may suffer nerve or spinal cord damage from direct trauma from a needle. This could potentially result in permanent nerve damage or paralysis.
• Allergic reactions to medications. The commonly used medications in this procedure include: Lidocaine, Bupivacaine, Ropivacaine, IV contrast dye, and corticosteroid (cortisone).
• Inability to complete the injection due to technical or anatomic difficulty.

Insurance requirements

Insurance companies have a series of requirements that must be met, prior to their approval of epidural steroid injections. These may vary between insurance companies, however; they commonly include:

• Physical Therapy – often a minimum of 4 weeksin duration
• Appropriate imaging, which may include X-raysor MRI.
• Documentation of failure to improve with otherconservative medical therapies