frequent procedures
FACET JOINT INJECTIONS
Facet joint injections or blocks are
procedures done in an attempt to diagnose and/or treat areas of pain
generation within the axial spine where facet joints are inflamed
and generating pain. These locations could be in the cervical,
thoracic, or lumbar spine, and each site of inflammation of these
small joints called facet joints, which are actually two lips of
bone contributing to above and below in each vertebra posteriorly in
order to articulate with the next vertebra and produce a slightly
mobile joint, which when used cumulatively allows the human spine to
bend forward and bend backward and not be a rigid entity. With each
facet joint contributing to small movements that allow these motions
of flexion and extension as well as lateral rotation to occur.
However, these small joints can become foci for inflammation and
pain generation or arthritis (osteoarthritis). Frequently, these
joints are contributors of the chronic pain syndrome and may or may
not require treatment with facet joint injections or blocks with or
without facet denervation procedures being done. The structural
anatomy of the facet joints differ from the lumbar to the thoracic
and the cervical, and even within each region, minor variations
occur at different levels of these facet joints, which are synovial
joints.
INDICATIONS:
TYPE OF FACET JOINT
BLOCKS: Facet joint blocks can technically
be approached through either an intra-articular injection during
which the interventional pain physician is able to access the facet
joints using tiny special needles under local anesthetic and
injecting into these joint capsules small amounts of a combination
of local anesthetic and Depo steroid under fluoroscopic guidance. An
alternative approach is to inject the nerves that supplies the facet
joint at specific locations depending on the level of the vertebra
involved in order to produce local anesthetic effects on these
nerves and use that as a diagnostic step to determine whether the
individual facet joint is contributing to the patient’s pain by this
technique. The injection is done at the suspected level and the
level above to achieve full block of transmission of pain from the
suspected facet joint. These injections can be both diagnostic and
therapeutic and some patients who undergo a successful facet joint
block may not require a subsequent facet denervation procedure to
achieve complete resolution of their pain. Facet joint blocks are
usually given in a series of two or three before a decision is made
regarding its efficacy or diagnosis.
COMPLICATIONS: The complications of facet joint injections
are rare in experienced hands. However, the risks associated with
facet joint injections become more prominent as the upper cervical
facet joint injections become approached, and these procedures like
atlanto-occipital and atlantoaxial joint injections should be done
by experienced trained pain management physicians in that area.
Other complications include infection, intravascular injection, and
injection into the CSF compartment with local anesthetic block that
is regional.
CONTRAINDICATIONS:
1. Patients that are pregnant or suspected to be pregnant should
notify the physician immediately to avoid exposure to x-rays.
2. Other contraindications include Coumadin and heparin or other
anticoagulants that may lead to prolonged bleeding. This
contraindication is relative in the sense that discontinuing the
anticoagulants for three days will usually enable the procedure to
be done successfully and the anticoagulation to be resumed. Before
and after the procedure, patients are allowed to continue other
medication that they are using like routine medications for blood
pressure control or headache. They are not required to fast before
this procedure is done. Patients may be given sedatives for this
procedure to be done if they request or their anxiety level demands
that. Otherwise, the procedure is benign and usually uneventful but
effective.
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