Fluoroscopy, a form of real-time radiography, is used to guide the placement of the needle in the facet joint.
Facet joint injections
are one of the most frequently performed procedures among all spinal interventions. Facet joint pain may be due to osteoarthritis, segmental instability, trauma, pinched meniscoid, and inflammatory synovitis. Patients with facet joint pain may have symptoms of neck pain, back pain, and pain that worsens with hyperextension, lateral flexion, and rotation.Facet joints are located in the vertebral column, where they connect the backbones to each other. They allow the spine to bend and twist. Like the knee or hip, facet joints have cartilage between the bones and a capsule filled with fluid to allow for smooth movement. When damaged, facet joints can cause debilitating neck or back pain. This condition is known as facet syndrome.
It can occur due to injury, overuse, or the onset of an inflammatory condition. In a study evaluating the adverse effects related to facet joint injections, serious complications were rare and were generally related to infections in patients over 60 years of age with underlying risk factors. Facet joints (cygapophysal joints) are found throughout the vertebral column and vary in size and shape depending on the vertebral level. If the injection does not relieve pain, it may be because the injection did not reach the source of the pain or because the pain is not caused by facet joints. Therefore, a key diagnostic question for patients with suspected facet pain is: “Does the pain extend below the knee or beyond the elbow?” with positive responses that decrease the likelihood that facet disease is the purported source of pain.
Before facet joint injections, it is recommended to try conservative treatments for at least 3 months, including multimodal treatment of medication, physical therapy and behavioral modifications. Facet joints are a pair of small joints located at the back of the spinal column, between each of the vertebrae. If radiofrequency ablation of the medial branches that innervate the facet joint is desired to obtain more lasting relief, the above test blocks should be performed only with local anesthesia (0.25 to 0.5 ml of 2% lidocaine or 0.5% bupivacaine) at the level of the medial branches. Based on the images, a 3.5 inch (5 inch) spinal needle of 22 to 25 caliber will be inserted into the facet joint and a contrast agent (0.2 to 0.5 ml) will be injected into the facet joint and a contrast agent (0.2 to 0.5 ml) will be injected. It should be noted that intra-articular injection of the facet joint does not serve as a diagnostic block in preparation for radiofrequency ablation. Injecting into the facet joint reduces pain in the small joints at the back of the spine, between the vertebrae.
Other causes of facet joint pain include degenerative spondylolisthesis, rheumatoid arthritis, ankylosing spondylitis, and septic arthritis. This activity will review the anatomy, indications, technique and complications associated with facet joint injections, and will highlight the role of the interprofessional team in treating facet joint pain. It consists of injecting medications close to branches of medial nerves which supply sensory information to facet joints. A facet joint injection is a procedure in which pain relieving and anti-inflammatory medications are injected into facet joints to reduce pain. Diagnostic injections in these small joints provide a reliable way to detect pain that originates in them and can provide patients with relief from their symptoms as well as guidance for future interventions or treatments.