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Interventional Pain Management Treatments -
Facet Joint Injections

Facet Joint Injections

If you are living with chronic, unmanageable pain from facet syndrome or spinal arthritis, these therapeutic approaches offer both a quick resolution and long-term relief. Facet joint injection is used as a diagnostic and therapeutic tool to confirm that facet syndrome is the source of your pain. In addition, radiofrequency neurotomy (RF) may be recommended to offer the prolonged relief that you may not otherwise achieve. These procedures provide an effective treatment regimen that affords substantial, sustained pain relief. Experts in diagnosing and treating facet syndrome and arthritis, our pain specialists integrate these tools into an individualized treatment plan to help you to regain your life.

What is a Facet Joint Injection?
A facet joint injection is a precise diagnostic tool that also provides excellent therapeutic results. Using fluoroscopic (x-ray) guidance, physicians are able to see and accurately target the affected joint(s). Facet joints are the small joints located between each vertebra that provide the spine with both stability and flexibility. Facet syndrome occurs when one or more of these joints become inflamed or irritated. Arthritis occurs when the cartilage lining the joint surface shrinks and wears thin, causing stress on the bone (bone spurs), inflammation, and enlargement of the joint.

Facet joint injections combine a local anesthetic and a corticosteroid anti-inflammatory medication. This mixture relieves both pain and inflammation coming from the involved joint. A successful result supports the diagnosis that the facet joint is indeed the “pain generator” and the cause of your back pain. Because they are performed using local anesthetic, facet joint injections offer the advantage of providing immediate feedback in confirming the source of your pain.

Initially, a local anesthetic is applied, then a small spinal needle is inserted into the facet joint, and anesthetic and medication are injected using fluoroscopic (x-ray) guidance. The anesthetic makes this procedure easy to tolerate.

Your doctor will review your medical history thoroughly before the procedure. You may be asked to undergo an imaging test to help your doctor plan for the treatment. The doctor might recommend you stop taking blood thinning medications 3 to 5 days before an ESI. You will be advised to eat light food before the treatment.

The ESI procedure generally takes 15 to 30 minutes. Patients are awake during the procedure. If you feel anxious about the procedure, then the doctor may give you a sedative. You will lie face down on the table. A local anesthesia may be given to numb the skin before giving the injection. The doctor uses fluoroscope (live X-ray) to direct the needle to the epidural space. Steroid medication is delivered to the nerve root close to the area of inflammation. The approach of injection depends on your condition.

Translaminar ESI: The injection needle is placed directly from the middle of the back to the interlaminar space (between the lamina of 2 vertebrae). This allows your doctor to access the epidural space. The steroids are delivered to the nerve roots on the inflamed area.

Transforaminal ESI: The injection needle is placed in the neural foramen, on the side of the vertebra. This allows your doctor to access the area outside the epidural space just above the opening of the nerve root. This procedure uses X-ray to help confirm the flow of medication (combined with contrast dye) after injection. It is usually preferred for patients who previously underwent spine surgery.

You will be monitored for a short while after the procedure, during your recovery period. You are encouraged to walk around immediately after the procedure. You may experience mild discomfort at the site of injection. Soreness in the injection site can be relieved by using ice packs. You will be advised to resume your normal activity on the next day after ESI. You may have to go to your doctor for a follow-up visit after a week of the procedure.

The risks associated with ESI include bleeding, infection, allergic reaction and nerve damage. The steroid medication used in ESI might have some side effects such as weight gain, hot flashes, mood swings, high blood sugar levels and sleeplessness.

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