Facet Joint Injections

What are Facet Joints?

The facet joints are located on each level of the posterior aspect of the spine, with one located on each side. They can be found in the cervical, thoracic, and lumbar spine. The facet joints are synovial joints which have articular cartilage that covers the ends of the bones. Articular cartilage has a smooth and shiny surface allowing the ends of the bones to slide freely over each other. In addition, the facet joint is surrounded by a protective sleeve of soft tissue called a capsule, and is lubricated by synovial fluid. Each joint can be a source of pain if irritated or inflamed.

The facet joint injection procedure consists of placement of an anesthetic and anti-inflammatory (steroid) solution. The purpose of this injection is to decrease inflammation and irritation caused by the joints, thereby reducing spinal pain. The procedure may be repeated periodically, if necessary, and is an important part of treating such conditions as chronic spine arthritis, degenerative disc disease and facet syndrome. It can be performed in the cervical, thoracic or lumbar regions. All procedures are done under fluoroscopic guidance (X-ray guided) to ensure proper placement of the medication and may be performed in an ambulatory surgical center, fluoroscopy suite or hospital setting.

Facet Joint Injections can serve two purposes: diagnostic, to define the joint that is the source of the pain, and to provide pain relief with the injection of a steroid to the inflamed joint. This is called a facet block. The use of facet injections serve as an adjunct to physical therapy to help restore normal function of the affected area.

The injection itself only takes a few minutes, but the entire procedure usually takes between 30 and 60 minutes. Patients may have relief of symptoms immediately after the procedure, but it can take several days and up to one week to determine whether the injection was helpful.

Facet joint irritation is a common cause of neck, back, arm and leg pain. Facet joints, like other synovial joints, are susceptible to wear-and-tear, degeneration, inflammation and arthritic changes. Inflammation and degenerative changes to the facet joints may result in pain, loss of motion, and – if severe – encroachment or pinching of the nerve exiting the spinal column.

Cervical Facet Joints

Symptoms can vary from mild to severe and may mimic the symptoms of a disc problem. Other common symptoms include:

• Pain in the neck, shoulder blades or pain that radiates out to the shoulder and into the arm. Pain is rarely felt in the hand or fingers.
• Headaches
• Pain and tenderness localized at the level of the involved facet joint.
• Muscle spasms and changes in posture in response to the injury.
• Loss of motion of the neck, including an inability to turn the head, look up or bend backward, or move sideways to the effected side.
• Sitting for extended periods of time or performing activities over-head is difficult.

Thoracic Facet Joints

Symptoms can vary from mild to severe and may mimic the symptoms of a disc problem. Common symptoms include:

• Pain in the mid back or radicular to the shoulder blade, ribs and chest.
• Pain and tenderness localized at the level of the facet joint that is involved.
• Muscle spasms and changes in posture in response to the injury.
• Loss of motion, like the inability to bend backward, move sideways to the effected side, stand erect or poor tolerance to sitting
• If the pain is severe enough, standing and walking is difficult.

Lumbar Facet Joints

Symptoms can vary from mild to severe and may mimic the symptoms of a disc problem. Other common symptoms include:

• Pain in the back or radicular to the buttock and down into the leg, to behind the knee, but rarely in the front of the leg or to the foot.
• Pain and tenderness localized at the level of the facet joint that is involved.
• Muscle spasms and changes in posture in response to the injury.
• Loss of motion like the inability to bend backward, move sideways to the effected side, stand erect or poor tolerance to sitting
• If severe enough, activities like standing and walking are difficult.

Common conditions of the facet joints include spondylosis, osteoarthritis of the spine, facet joint inflammation, degenerative joint disease of the spine and facet arthropathy.