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Facet joint injections

Published by Bupa's health information team, July 2009.

This factsheet is for people who are planning to have facet joint injections, or who would like information about them.

Facet joint injections are injections of local anaesthetic and steroids into the facet joints of the spine under X-ray control.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

About facet joint injections
Preparing for your procedure
About the procedure
What to expect afterwards
Recovering from facet joint injections
What are the risks?
Questions and answers
Related topics
Related Bupa products and services
Further information
Sources

About facet joint injections

The spine is made up of bones called vertebrae. They are separated by strong shock absorbers called discs, which allow the spine to bend. The facet joints link the vertebrae together, and help to stabilise the spine and control the degree of movement as well as carrying some of the load. With age, they become more prone to injury and wear and tear, and are a common cause of lower back pain.

Illustration of the different parts of the spine
The different parts of the spine

Facet joint injections can be used to both treat and diagnose back pain. To diagnose whether or not a facet joint is the cause of your back pain, local anaesthetic can be injected into the joint. You may also have a steroid medicine injected at the same time. If your pain improves within a few hours or a couple of weeks, this suggests that the facet joint is causing your back pain.

The steroid medicine can also treat pain, inflammation and any restriction of movement caused by wear and tear.

It can take between seven and 10 days to feel the full benefits of a steroid injection. The effects of a successful injection can last anything from a few days to a month, but the benefits rarely last longer than six months. Facet joint injections may reduce your pain enough to allow you to do some exercise and stretches. Repeat injections in the same area aren't usually recommended and many people find that their back pain and mobility don't improve after the injections.

Facet joint injections are usually only done if you have had back pain for longer than six weeks and you have tried other conservative treatments suggested by your doctor, such as painkillers or physiotherapy. They aren't done if you have an allergy to local anaesthetics or steroids.

Preparing for your procedure

You may be asked to stop taking certain medicines before your facet joint injection. You may also be asked not to take any pain relief medicines for at least four hours before the procedure. Your surgeon should explain which medicines to stop before your procedure as this will depend on your individual needs.

Facet joint injections are usually performed as an out-patient or day-case procedure under local anaesthesia and X-ray control. This completely blocks feeling from the spine and you will stay awake during the operation. You may also have sedation. Sedatives relieve anxiety and cause temporary relaxation without putting you to sleep.

At the hospital your nurse may check your heart rate and blood pressure, and test your urine.

Your doctor or another health professional will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

About the procedure

Facet joint injections take between 30 and 60 minutes and are usually performed in the X-ray department or operating theatre. The procedure is usually done by a doctor in pain medicine, spinal surgery or radiology.

Before the procedure begins, you will have a small plastic tube (cannula) placed in a vein in the back of your hand. This can be used to give you sedatives, or other medicines if necessary, during your treatment. If sedatives are given, you will feel relaxed and drowsy.

You will probably be asked to lie on your stomach to have your facet joint injection. Your skin will be cleaned at the site of the injection with a sterile antiseptic wipe. Local anaesthetic may be injected into your skin prior to insertion of the needle.

A thin needle is passed through the skin of your back into the facet joint. Your consultant may inject a special dye (contrast medium) into the joint first. This will show on an X-ray whether or not the needle is in the correct place. The steroid and local anaesthetic mixture is then injected into the joint. You may be asked during the procedure whether you feel any pain.

The treatment usually only takes a few minutes, and more than one joint can be injected during the same session. Facet joint injections can be uncomfortable because they are given in an area that may already be painful.

What to expect afterwards

After a local anaesthetic it may take several hours before the feeling comes back into the treated facet joints. Take special care not to bump or knock the area. You should be able to walk immediately after the procedure, although some people have some tingling or numbness for a few hours.

Your doctor may ask you to perform a task that usually causes you pain to assess how much pain relief you have got from the procedure.

Sedation temporarily affects your coordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, please contact your motor insurer so that you're aware of their recommendations, and always follow your doctor's advice.

Recovering from facet joint injections

After facet joint injections, you should rest your back for 24 hours. This means that you should take it easy, but you shouldn't stay in bed. Within the first few days you should start to move your back as usual. You may experience an increase in your symptoms for up to two weeks after your facet joint injection, particularly if you had a very painful back before the procedure. You must follow your doctor's advice about returning to work and exercise.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Alternatively, you may want to use ice or a bag of peas, wrapped in a towel, to numb the area. Don't apply ice directly to your skin as it can damage your skin.

It can take up to two weeks for the injection to take effect.

During the first few days, if you feel unwell or develop any of the following, contact your doctor or hospital immediately:

a fever or high temperature
severe pain or a headache
loss of bladder or bowel control
redness around the injection site

What are the risks?

Facet joint injections are commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure. You will be exposed to some X-ray radiation during facet joint injections. The amount of radiation you will be exposed to will depend on the number of X-rays you need to have done and how many facet joints need injecting.

If you're pregnant

Although the radiation dose used is generally thought to be safe for adults, it may possibly harm a developing fetus. If you think you are or could be pregnant, tell your doctor before your appointment, as you won't be able to have a facet joint injection while you are pregnant.

Side-effects

These are the unwanted but mostly temporary effects of a successful procedure.

After a facet joint injection you may feel more pain and tenderness in the area. You may also have some bleeding or an infection.

The steroid injected into the facet joint may also cause some side-effects in a very small number of people. These can include:

fluid retention
weight gain
high blood pressure
mood swings
insomnia

Complications

This is when problems occur during or after the procedure. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection or excessive bleeding.

Complications of facet joint injections are rare but can be serious.

One possible complication of any injection into the spine is that the treatment goes into the wrong part of the spinal cord. This can cause a drop in your blood pressure or widespread numbness. Your doctor will monitor you constantly, and will be able to notice this quickly and provide appropriate care. The risk of this is minimised by the use of X-rays.

Other possible complications include inflammation of the nerves in your spine, and damage to nerves or tendons near the joints being injected. There is also a very small risk of infection in the joints.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your doctor to explain how these risks apply to you.