Cervical or Thoracic Facet Joint Injection (Facet Joint Block)
The paired joints in the spine, called facet joints, can become arthritic or injured and cause pain.
The Facet Joints
The facet joints are the small joints between the vertebral segments on both sides of the spine. Each vertebral segment has two facet joints, one on each side. These joints provide stability. The cervical facet joints guide motion in the neck, and the thoracic facet joints guide motion in the mid-back. Just as a joint in your finger, knee, or hip can cause you discomfort, so can the facet joints in your neck and back. Pain from the cervical facet joints may be in the head, neck, upper back, and shoulders. Pain from the thoracic facet joints may be in the mid-back.
The Purpose of the Facet Joint Injection
Injections into the facet joints are done in an attempt to decrease pain and inflammation. A steroid is injected to decrease inflammation that may be present in the facet joints. The steroid usually starts to work in 2 to 3 days; the optimal effects are not known until 1 to 2 weeks after the injection. The pain relief from therapeutic injections may vary in duration and degree from none to long term.
The Procedure: Facet Joint Injection
The patient is placed in the prone (lying face down) position with two pillows under the chest and a small pillow under the forehead. The skin over the back of the neck (for cervical) or mid-back (for thoracic) is sterilely prepared. The facet joints to be injected are imaged with fluoroscopic (X-ray) guidance. The skin is anesthetized. A thin needle is then advanced under X-ray guidance into the posterior or back portion of the appropriate facet joint. A small volume of contrast solution is injected, which proves that the medication will flow within the joint. Then a small volume of anesthetic with steroid solution is injected. The patient is cared for in the recovery area for 20 to 30 minutes.
Preparing for the Facet Joint Injection
- While the procedure may take less than 30 minutes, you should allow for at least 1 hour at the procedure center.
- You need to arrange for a driver to be present and take you to and from the medical facility. If you do not have a driver with you, your procedure may have to be rescheduled.
- If you develop a fever, night sweats, or an active infection, your procedure will need to be rescheduled. Please contact our office at (651) 968–5201 immediately to inform us of your change in condition.
After the Facet Joint Injection
Follow the specific instructions given to you by the nurses at the procedure center.
- Rest for a few hours, resume activity as tolerated, and use assistance as needed. Do not overexert yourself the first day.
- For discomfort, apply ice packs to the area for 15 minutes several times a day.
- Do not soak in a tub for 24 hours after the procedure. You may take showers.
- Observe for any signs of infection, including redness and warmth at the injection site, increasing pain, swelling, drainage, chills, night sweats, or fever that reaches above 100° F. Report any signs of infection or other unusual symptoms.
- Keep a record of your pain and symptoms in the immediate hours after the injection, and report your results as instructed by the nurses at the procedure center.
Remember that your usual pain may go away for a few hours, but after the local anesthetic wears off, it is normal for your pain to return. You may also have some temporary discomfort at the puncture site. The full effects of the steroid may take 2 days to 2 weeks to work, and its lasting effects vary from person to person.
Possible Side Effects of the Steroid
Possible side effects include facial flushing, fluid retention, insomnia, low-grade fever, temporary changes with menstruation, and headache. These side effects usually are minimal and resolve 1 to 3 days after the procedure. If you have diabetes, your blood sugars may be temporarily elevated.
Potential Risks of Facet Joint Injections
The risks are quite minimal, but are similar to any procedure involving a needle placement. These include, but are not limited to:
- Allergic reaction to the anesthetic or X-ray dye. Be sure to inform us before the injection if you have any known allergies.
- Irritation of the injected structure, which could cause temporary worsening pain.
If Your Procedure Includes Sedation
- You should have no solid foods for 6 hours before your procedure.
- You may have clear liquids up to 2 hours before your procedure. Examples include: water, broth, clear fruit juices such as apple, cranberry, and grape juice. These juices should not include pulp. Tea, black coffee with no cream, and carbonated beverages are also allowed.
- Nothing by mouth, including throat lozenges, mints, and all hard candy.
- No gum for 2 hours before your procedure.
- You must have a responsible adult arrive with you to our facility. If you use a taxi or volunteer ride service, you still must have a responsible adult with you in order to help take care of you after your sedation procedure.
- Please take your regular medications the day of your procedure, especially any heart or blood pressure medications.
- If you are on medication for diabetes, be sure to take it the day of the procedure.
Learn more about the factors that increase your risk for a vertebral compression fracture.
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