Facet Joint Injections

Introduction

The facet joints are small joints between vertebral bodies which extend from the base of the skull to the lowest joint between the 5th lumbar vertebral body and the sacrum. An identical joint, in a different plane exists on each side in a mirror image fashion. The joints of the spine are designed to allow movement of the spine in a number of different planes and are separated by a lubricated membrane, the synovial membrane which allows the joint surfaces to glide over one another.

With advancing age wear and tear occurs in the facet joints resulting in loss of the joint lubrication, contact between bony surfaces and the triggering of pain. Pain from a lumbar facet joint can trigger secondary muscle spasm resulting in stiffness associated with pain. Classically therefore the patient with worn facet joints who becomes symptomatic will complain of stiffness in the lumbar area which is particularly pronounced in the mornings and often only relieved by mobilisation or a hot bath. Typically the pain is present in the lumbar region but may be referred to the legs particularly the buttock area and the posterior area of the thighs. This pain referral to the legs is not defined as sciatica. Sciatica itself is defined as pain which is perceived distal to the knees and is usually indicative of a different cause such as a prolapsed intervertebral disc or piriformis syndrome. Movements which extend the spine backwards usually result in an exacerbation of the pain and this form of pain is particularly prominent during prolonged periods of standing or sitting.

The technique of lumbar facet joint injection

At Joint Reaction lumbar facet joint injections are performed on a day case basis under sedation to ensure the maximum comfort of the patient and utilising x-ray control to ensure optimal placement of the injection treatment. Injection may take place into the joint itself employing local anaesthetic and steroid combinations or alternatively the nerve supplying painful sensations (and only painful sensations) to the joint may be blocked either on a temporary basis using a local anaesthetic or more permanently employing a technique called radiofrequency lesioning. The latter technique is more complex and employs cutting edge technology but associated with a slightly higher risk of complication.

As mentioned above the injections are accomplished under x-ray control and with the benefit of sedation. After injections patients are usually discharged from the hospital within approximately 4 hours. At Joint Reaction we generally advise patients to take one to two days leave from employment as not infrequently there is a short term exacerbation of pain prior to the commencement of improvement. The onset of improvement is often several weeks post injection as usually a long acting steroid is employed which pharmacologically has a slower onset of action. The maximum benefit from this treatment usually occurs after approximately 10 – 12 weeks post injection and the best results are obtained if injection is combined with post injection physiotherapy, chiropractic or osteopathic treatment.

If you are receiving anticoagulant therapy such as Warfarin, have a known allergy to local anaesthetics, are pregnant or have local or systemic infection it is inadvisable to undergo facet joint injection. If you are concerned about matters such as this it is advisable to discuss these matters with your specialist prior to consideration of facet joint injections.

The purpose of facet joint injections is to render the patient increasingly mobile with decreased levels of pain. Statistically approximately 70% of patients will derive a reduction in their pain levels of at least 50%. Risk factors are absolutely minimal. The quoted figures for nerve injury are of the order of 1 in 10,000 and other complications are of a minor degree including a brief exacerbation of pain, bruising or pain at the site of injection.

Clare Park Hospital | Crondall Lane | Crondall | Farnham | Surrey | GU10 5XX

© Joint Reaction 2008