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Facet Joint Injection

 

Zygapophysial joints, better known as facet or “Z” joints, are located on the back (posterior) of the spine on each side of the vertebrae where it overlaps the neighboring vertebrae. The facet joints provide stability and give the spine the ability to bend and twist. They are made up of the two surfaces of the adjacent vertebrae, which are separated by a thin layer of cartilage. The joint is surrounded by a sac-like capsule and is filled with synovial fluid (a lubricating liquid that reduces the friction between the two bone surfaces when the spine moves and also nourishes the cartilage.)

 

There are basically two reasons for having a facet joint injection:
        1.  Diagnosis (to determine the source of pain).
        2.  Therapy (to treat an abnormality that has been detected).

 

Most back pain will improve within a few weeks by itself, or with conservative treatments such as rest, anti-inflammatory medications, physical therapy and exercise. If you suffer from back pain for more than six weeks and conservative treatments have not helped, or if your pain has increased, your physician may order diagnostic tests such as magnetic resonance imaging (MRI) or computerized tomography (CT) scans to look at the structures of the spine. A problem (such as inflammation, irritation, swelling or arthritis) in the facet joint may cause low back pain. If these diagnostic tests show an abnormality in a facet joint, it may be the source of the pain.

 

To determine if a facet joint is truly the source of back pain, an injection (sometimes called a “block”) may be prescribed. If an injection of a small amount of anesthesia into the facet joint reduces or removes the pain, your physican is assured that the facet joint is the source of the pain. This is diagnostic use of the facet injection.  Once a facet joint is pinpointed as a source of pain, therapeutic injections of anesthesia and anti-inflammatory medications may give pain relief for longer periods of time.

 

Facet joint injections are performed while you are awake, under a local anesthetic, and able to communicate. Sometimes, your physician may also administer drugs to make you more comfortable during the procedure. The injection is usually performed while you are lying on your stomach on an X-ray table. EKG, blood pressure and blood-oxygen may be monitored prior to and during the injection process.

 

During the procedure, you probably will undergo a fluoroscopic X-ray that allows your physician to place the needle in the correct facet joint. Your physician will use a local anesthetic to numb the skin over the injection site. He will inject the joint with a contrast (dye) that will be identified on the X-ray to ensure he has the proper site for injecting the medications.

 

Once the proper site has been determined, your physician will inject the anesthetic and the anti-inflammatory. You may be asked whether you are experiencing pain relief or not, to make sure the injection is in the right place and determine if additional injections are needed. This process may then be repeated depending on the number of affected facet joints. Although the actual injection takes only a few minutes, the overall procedure usually takes approximately 30 to 60 minutes.

 

Immediately following the procedure, you may feel a reduction or complete relief of your back pain. Your physician may ask you to perform a task that would normally cause pain to assess the level of pain relief. You will be able to walk immediately after the procedure, although some patients may experience leg weakness, numbness or tingling for a few hours after the injection. Because your reaction times may be affected by the medications, driving is not recommended immediately following the injection. You should have someone who is available to drive you home following the procedure.

 


Copyright 2015 Dr Mel Richardson
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