Diagnostic / Therapeutic Facet Joint Injections
The facet joints are located in the cervical, thoracic and lumbar spine. They are located beside the vertebral bodies and help the spine have mobility. The facet joints are located on each side of the vertebral bodies and can be injured by blows to the spine, sports injury and motor vehicle injuries.
Lumbar facet joint injuries are usually common in motor vehicle injuries. The symptoms are pain, swelling of the lumbar area and restricted movement of the spine. The diagnosis of the facet joint pain involves injecting lidocaine or a similar anesthetic near the joint that is painful. If the problem is correctly located, the pain will temporarily resolve itself and the diagnosis is sound. The injection is known as a facet joint block.
In a nerve block, there is a high rate of non-response, indicating that it may take a skilled provider and more anesthetic per block to get an accurate response.
Therapeutic Facet Joint Injection
There is evidence that therapeutic facet joint injection can help those living with chronic arthritis of the facet joint that doesn’t get better with other treatments. The treatment is quick and can be long lasting. Once the facet joint disease is diagnosed with a diagnostic nerve block, the doctor can use therapeutic injections to relieve the pain.
The facet joint injection uses fluoroscopic/x-ray diagnosis, the location of the facet joint can be pinpointed for later injection. Facet joint syndrome occurs when there is inflammation of the joints. The joint becomes inflamed and bony spurs occur. Between the vertebrae at the level of the facet joints on either side of the vertebral body is where the injections occur.
A therapeutic facet joint injection involves a local anesthetic and epinephrine to keep the anesthetic in one place for as long as possible. If the facet joint is the source of the pain, both the diagnostic and therapeutic facet joint injections will relieve the pain. There is immediate feedback at the time of the injection. Initially, the doctor inserts a local anesthetic using a regular needle. Then a spinal needle is inserted into the facet joint itself and a local anesthetic is applied to the facet joint itself using fluoroscopic guidance.
Another treatment is radiotherapeutic denervation, which adds heat to the affected area. This damages the nerves around the affected nerves. The is also called a radiofrequency neurotomy or ablation. The deadened nerves can no longer send off a signal indicating pain. This procedure is uniquely safe and can be done as an outpatient.
Facet joint injections on average take about 20-30 minutes each. A radiofrequency neurotomy takes about 30-60 minutes. If there are many levels involved, the procedure takes longer. The procedures don’t last forever. A facet joint injection lasts about six months before another injection is needed. A radiofrequency neurotomy procedures tend to last longer—up to a year’s time.
Facet joints treatments are generally very safe and can be repeated for several years. After the procedure you will have sore back or neck for one to two days. You can return to regular activities after a day or two. Relief from these injections begins at about the third day.