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Facet Block Injections

Facet injections are a common treatment for patients with back pain that manifests in the facet joints, the joints that connect two vertebrae and allow the spine to perform bending and twisting motions. Over time, the cartilage that lines the spine’s facet joints, which make motion smooth and pain-free, begins to wear down. In some instances, the cartilage can wear down completely and leave the bones in the facet joints to grind against each other, which irritates nerve endings in the joint. This potentially results in pain, stiffness and limited range of motion.

How are facet injections given?

Facet injections are often used to temporarily relieve a patient’s facet joint pain so that he or she can more easily withstand the physical therapy necessary to help rehabilitate the spine. During a facet injection, a physician begins by treating the skin over the affected facet joint with a numbing medication, which allows the facet injection to be as painless as possible. The physician then uses X-ray guidance (fluoroscopy) to insert a needle into the facet joint at issue. Contrast dye is then injected to confirm that the needle is inserted into the joint. Once the needle is in place, a mixture of an anesthetic (often lidocaine) and a steroid (often cortisone) is injected into the affected facet joint. Facet injections can be given for back pain in any region of the spine where the patient is showing signs of facet joint degeneration, including in the:

Facet injections as a diagnostic tool

Facet injections are not only used for back pain treatment — they can also help a physician diagnose a patient’s spine condition. There are a number of spine conditions that can cause pain, stiffness and limited range of motion, so arriving at a diagnosis may prove difficult. If a physician suspects a facet joint is the cause of a patient’s symptoms, however, he or she may administer a facet joint injection. If the patient experiences relief after the injection is given, it is probable that the physician has identified the source of the patient’s discomfort.

Neck (cervical spine)

Facet injections in the neck may help relieve pain

Patients who are struggling with pain from facet joints in the cervical spine may be advised to get facet injections in the neck. This refers to when an injection composed of an anesthetic, like lidocaine, and a steroid, like cortisone, is injected into a facet joint in a patient’s neck. Facet joints are the joints that allow for movement within the spine. Healthy facet joints are lined with cartilage that allows this motion to be smooth and painless. Due to the immense stress our spines endure on a daily basis, however, this cartilage can wear down over time, leaving the bones in the facet joints to rub against each other without any protection. When this occurs, nerve endings in the joint become irritated and an individual will likely experience pain and inflammation within the facet joints, as well as stiffness and a limited range of motion.

What do facet injections do?

Facet injections in the neck have two goals. They are to:

  • Diagnose the cause of the patient’s pain. Because a number of different spine conditions can result in pain and stiffness, it is often not immediately clear if and when a facet joint is the source of a patient’s symptoms. By injecting numbing medication into a specific facet joint in the cervical region of the spine, however, a physician can confirm whether the joint is a source of pain, depending on whether the patient experiences immediate relief following the injection.
  • Provide the patient with meaningful pain relief. In addition to lidocaine or another numbing medication, facet injections also include cortisone, a steroid that continues to work after the effects of the lidocaine have worn off. The cortisone can help to reduce inflammation in the joint, providing the patient with more meaningful pain relief.

How is a facet injection administered?

Getting facet injections in the neck is a relatively simple process. While the injection itself will only take a few minutes, the entire process from start to finish typically takes somewhere between 15 to 30 minutes. The patient will begin by lying face down on a table. The physician performing the procedure will cleanse the area of the skin where the injection will be given and will then administer a shot to numb the area. He or she will then use fluoroscopy, or X-ray guidance, to guide a thin needle into the affected facet joint and then inject contract dye to ensure it is in the right location. Once the needle is in place, the physician will administer the facet injection.

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Back (thoracic spine)

Facet injections in the back often help patients control their pain

Facet joints connect vertebrae and allow the spine to perform the complex twisting and bending motions we make every day. In healthy facet joints, the bones are lined with cartilage, allowing for smooth, pain-free movement. As with other parts of the body, however, the cartilage that lines the facet joints can wear down over time, and for some, the cartilage may wear away altogether. This leaves nerve endings in the joint exposed to irritation, and allows bones to rub against each other without any protection.

Diagnosing facet joint pain

When the bones in a facet joint rub against each other without the protective layer of cartilage, an individual may experience pain, inflammation, stiffness and a limited range of motion. There are several other spine conditions that may cause similar symptoms, however, which can make it difficult to arrive at a definitive diagnosis. Facet injections in the back allow physicians to determine if a facet joint is the source of a patient’s pain, as well as identify the specific joint that is inflamed.

To administer a facet injection into a joint in the thoracic area of the spine, a physician will begin by asking the patient to lie face down. He or she will then clean the area to be treated and inject the skin with a numbing medication. Once the area is numb, the physician will use X-ray guidance to insert a small needle into the facet joint, using contrast dye to ensure correct placement of the needle. Finally, the facet injection, which is a combination of an anesthetic and a steroid, will be given. If the patient experiences immediate symptom relief following the injection, the physician has likely identified the source of the pain.

Conservative treatment for facet joint pain

Many patients experiencing pain and stiffness in their facet joints will be prescribed a regimen of conservative treatments in an attempt to manage their pain without surgery — and this attempt is often successful. Facet injections in the back can be an effective form of treatment, as the steroid in the injection may help to reduce inflammation within the affected joint, in addition to the temporary pain relief caused by the anesthetic. In addition to facet injections in the back, a patient undergoing conservative treatment for facet joint pain may take advantage of pain and anti-inflammatory medication, physical therapy and hot-cold therapy.

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Lower back (lumbar spine)

Receiving facet injections in the lower back

Facet injections in the lower back are used to diagnose and treat individuals whose lumbar facet joints have become damaged or arthritic to the extent that they are causing symptoms and impacting quality of life. Facet joints are the cartilage-lined joints that allow for movement in the spine. As we age, the cartilage that lines the facet joints begins to degenerate. For some individuals, this cartilage may wear away completely, leaving the nerve endings and bones in the facet joints to grind against each other. This can cause a number of symptoms, including mild to debilitating pain, stiffness and a limited range of motion.

Diagnosing facet joint pain with injections in the lower back

If a physician suspects a patient’s pain is manifesting in the facet joints, he or she may suggest that the patient undergo a facet injection to confirm the diagnosis. Before the injection is administered, the physician will treat the skin over the facet joint with a numbing medication. Once the area to be tested is numb, the physician will use X-ray guidance to insert a needle into the facet joint that is the suspected source of pain, using contrast dye to confirm that the needle has been placed correctly. Then, the physician will put the facet injection, which is a mixture of anesthetic and anti-inflammatory medication, into the joint. If the patient’s pain subsides as soon as the injection is given, the diagnosis can be confirmed.

Treating facet joint pain with injections in the lower back

After a physician identifies which facet joint in the lumbar region of the spine is the cause of a patient’s symptoms, he or she will recommend a course of treatment to relieve the patient’s pain and help them reclaim their life from facet joint pain. For most patients, this treatment begins conservatively, without surgery. Some commonly used conservative treatments include pain medication, physical therapy and hot/cold therapy. Additionally, a physician may recommend that the patient continue to get facet injections in the lower back. In addition to numbing the affected joint to allow the patient to better withstand physical therapy, facet injections can help reduce inflammation in the joint thanks to the cortisone steroid in the injection.

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