Introduction
Facet joint injections are a common method for alleviating pain caused by inflammation in the spinal joints.
Our ultrasound-guided injection services are both cost-effective and easy to access. You can schedule your appointment directly, without requiring a referral from another healthcare provider. This simplified process ensures you can promptly receive the treatment you need.
This information is intended to ensure you have all the details you need about the procedure. It’s important that all patients have accurate information to make a well-informed decision before scheduling an injection
What is a facet joint?
Your spine is composed of a series of bones known as the vertebral column. These vertebrae bones are connected by small facet joints and cushioning discs that sit between them. Facet joints are small joints that link the vertebrae together, located on either side of each vertebra along the entire length of the spine—throughout the neck (cervical spine), upper back (thoracic spine), and lower back (lumbar spine). They enable spinal movement and provide stability.
These joints can experience wear and tear, inflammation, and irritation, which may lead to spinal pain that doesn’t always respond to standard treatments like physiotherapy and over-the-counter pain medication.
Pain originating from facet joints in the lower back can radiate to the buttocks and upper legs. When facet joints in the neck are affected, the pain may extend to the back of the head, upper back, and shoulders. Additionally, irritation of the facet joints can cause nearby muscles to become tight and painful.
What is a facet joint injection?
Facet joint injections are a minimally invasive treatment that involves injecting local anaesthetics and steroid medication into and around a facet joint where there is a small nerve connected to the facet joint.
The local anaesthetic makes the procedure less painful and numbs the nerves to the facet joint to give pain relief and the steroid helps to reduce inflammation to give longer lasting pain relief.
Facet joint injections are only used if conservative treatments have not been effective and should be used in combination with physiotherapy and exercise to get the best result.
Why would I need a facet joint injection?
Facet injections are generally offered following failure to improve from a period of conservative treatments such as physiotherapy, osteopathy and medication.
Facet joint injections are used when pain and irritation from the facet joints is suspected. The main goal of a facet joint injection is to reduce inflammation, relieve pain and break the pain cycle, enabling you to engage in physiotherapy and rehabilitation.
The number and location of facet joint injections that require an injection varies depending on your specific condition. Some patients may require a single injection, while others might need injections at multiple levels of the spine. Additionally, some patients may need injections on both sides of the spine, while others may only require treatment on one side. In certain cases, facet joint injections may be combined with other types of injections to achieve the best outcome such as a nerve root injection or epidural.
To determine the most appropriate course of treatment, our consultant will conduct a thorough examination and review your MRI scan before the procedure. Please note that all patients must have an up-to-date MRI scan before booking a procedure. If you would like to discuss this further, please contact us.
What is in the injection?
The injection contains a combination of a corticosteroid (often referred to as a steroid or cortisone) and a local anaesthetic. The local anaesthetic acts quickly, providing immediate but short-term pain relief by numbing the area. This helps to ease discomfort during and shortly after the procedure. The corticosteroid, on the other hand, is designed to reduce inflammation in the facet joints. While it may take longer to feel its effects, the corticosteroid offers longer-lasting relief by addressing the underlying inflammation that contributes to your pain.
It’s important to understand that while these injections have a high success rate, individual responses can vary. Some people may experience significant and prolonged relief, while others may find the benefits to be shorter-lived. The effectiveness of the injection depends on several factors, including the severity of the condition, the specific cause of the pain, and how your body responds to the treatment. Your doctor will work with you to monitor the results and determine the best course of action moving forward.
What are corticosteroids?
Corticosteroids are powerful anti-inflammatory medications commonly used to treat a variety of musculoskeletal injuries and conditions. When injected directly into a facet joint, these steroids can effectively reduce pain and swelling by targeting the inflammation around the joint and surrounding nerves. It’s important to note that corticosteroids used in these injections are not the same as anabolic steroids, which are sometimes used by weightlifters and gym enthusiasts to increase muscle mass.
Unlike oral corticosteroids, which can sometimes cause side effects like weight gain when used over extended periods, the corticosteroids used in facet joint injections typically do not have this effect. Because they are administered directly into the affected area in small amounts, the risk of systemic side effects, such as weight gain, is significantly minimised.
The Procedure: What to Expect
You’ll need to fill out a medical screening and consent form, which will ask about any medical conditions you have and any medications you’re currently taking. This form must be completed prior to your procedure to ensure your safety and the effectiveness of the treatment.
It’s crucial that you provide a full and accurate account of your medical history and current medications. This information helps us assess whether it’s safe for you to proceed with the injection. In some cases, we may need to postpone your injection or seek approval from your GP first. For example, if you have unstable blood pressure or blood sugar levels due to diabetes, we may need to delay the procedure until these conditions are better managed. Your safety is our top priority, so it’s important that all relevant medical details are disclosed.
Important Information
- The procedure is conducted as a day case and typically takes about 20-30 minutes.
- You must arrange for someone to accompany you home after the procedure.
- Do not drive for 24 hours following the injection.
- You can eat and drink normally before the procedure.
- Continue taking your regular medications, but please inform us if you are diabetic or taking anticoagulants (blood-thinning medication).
- An up-to-date MRI scan of your back, ideally within the last six months, is required before the injection to accurately identify the treatment area.
What areas are injected?
The injection is done into one or more facet joints in the lower back or neck.
The exact joints that are injected depends on your pain location, physical examination, and MRI results.
Ultrasound guidance is used to ensure accurate placement of the needle and the safety of the procedure
How is the injection performed?
You will usually be asked to lie down on your front or in a side lying position with the area that needs to be injected exposed.
First, the skin is sterilised with an antiseptic and a local anaesthetic is administered to numb the area. Using ultrasound guidance, a thin needle is carefully inserted into the affected facet joint, the medication is injected and the needle is removed. This procedure is repeated for each joint being treated.
The entire injection process typically takes about 20 to 30 minutes. After the procedure, patients are monitored for up to 1 hour before being allowed to return home.
Why is ultrasound-guidance used?
Using ultrasound technology, our doctor will precisely visualise the targeted area for the injection, ensuring that the needle is placed directly into the affected region. This method ensures the effectiveness, accuracy of the injection and safety of the procedure. Research, including a study by Tao Wu MD et al. 2016 demonstrates that ultrasound-guided injections are as effective as those performed under fluoroscopy (X-ray), a traditional imaging technique. Using ultrasound technology, your doctor can precisely visualise the targeted area for injection, ensuring that the needle is placed directly into the affected region. Unlike fluoroscopy (X-ray), which primarily visualises bones, ultrasound can simultaneously image both hard structure such as bones/joints, and soft tissues, including ligaments, nerves, and surrounding muscles. This comprehensive view allows for more precise targeting and assessment.
Is the injection painful?
The injection can be uncomfortable, but this generally resolves quickly. It’s quite common to experience soreness around the injection site for a few days afterward, but the use of a local anaesthetic during the procedure helps minimise pain, although you might feel some pressure or a mild burning sensation when the medication is injected.
Approximately one in four individuals may experience a temporary increase in pain, known as a post-injection flare, within the first 24 to 48 hours after the injection. However, this discomfort typically resolves within a couple of days. You can use simple painkillers like paracetamol and by applying a cold compress to the area to help with these symptoms.
After the Injection: Recovery
You will be given a report of your diagnosis and treatment after the procedure which we suggest you forward to your GP to add to your medical records. It’s also a good idea to share this with any other healthcare professionals that you are working with and part of your recovery such as your Physiotherapist or Osteopath.
What happens after the procedure?
After the injection, you are advised to rest in the waiting room for 20-30 minutes before leaving the clinic.
If your injection included a local anaesthetic, you might experience some pain relief within minutes, although this typically wears off after a few hours. You may also experience some soreness at the injection site, which should subside within a few days.
The steroid usually begins to take effect within a few days to a week, but in some cases, it may take up to 2-3 weeks to feel the full benefits.
Most patients can return to normal activities after a few days. However, it’s recommended to take it easy on the day of the procedure and avoid strenuous exercise for about two days.
Your doctor will tell you if there are any specific post procedure instructions and what signs of complications to watch out for.
The improvement in symptoms varies from person to person. Your doctor will discuss follow-up care and what to expect in your recovery.
Will I Need Another Injection?
Whether or not you need another injection will depend on your response to the first one; if the injection provides good pain relief, and other treatments aren’t suitable or haven’t worked, you might benefit from having a repeat injection should your symptoms return.
Medical guidelines recommend that steroid injections should only be repeated to a maximum of three times in the same area within a 12-month period.
What are the benefits of having facet joint injections?
The benefits can include reduced inflammation and pain, improved mobility, and confirmation of the pain source, thereby aiding further treatment planning.
Most patients have a good response following a facet joint injection. However, the benefits are not always long lasting. The corticosteroid can take a couple of weeks to take effect, so you may not notice an immediate benefit.
These injections are not curative, but aim to alleviate the pain that is affecting your activity level and preventing you from functioning normally. They offer you a ‘window of opportunity’ to engage in rehabilitation which will help to provide better management of your symptoms and gain long term benefit.
The main benefits of a nerve root injection include:
- Significant temporary or long-term relief of back or neck pain.
- Improved activity level and quality of life
- Breaking the pain cycle allowing you to take a more active part in your rehabilitation
- Diagnosis – if your pain subsides it gives you clarity on the specific cause of your symptoms
- A reduced need for surgery
Are there any reasons I can’t have a nerve root injection?
This procedure is generally avoided in patients with the following:
- Systemic infections
- Skin infections over the injection site
- Bleeding disorders or patients taking blood thinning medication
- Allergies to the steroid medication or anaesthetic
- Progressive neurological disorders
- Pregnancy Pregnancy or breastfeeding mothers
- Uncontrolled diabetes and heart disease
- Tumours or cancer
What are the risks of facet joint injections?
Adverse reactions from facet joint injections are rare, and your doctor will take all necessary precautions to minimise any risks or complications from your procedure. However there are some potential risks with any procedure.
Potential side effects:
- Local tenderness, swelling, bleeding and bruising at the site of the injection
- Weakness, tingling or numbness in limbs for a few hours to days
- Vasovagal episode (fainting)
- A temporary worsening of pain for a few days
Rare But More Serious Side Effects:
Infection
Very occasionally, the area where the injection was given may become infected. Or In rare cases (about 1 in 50,000) a joint or tissue structure inside the body can become infected.
If the area becomes more painful, hot, red, and swollen, seek medical attention immediately. Other signs of infection include feeling generally unwell, such as having a fever or nausea.
Spinal disc infections (discitis) are very rare but are considered a medical emergency and require immediate treatment.
Anaphylaxis
Allergic reactions to steroids or local anaesthetics are extremely rare (about 1 in 500,000). If a reaction occurs, it usually happens within minutes and needs immediate medical attention. Symptoms can include feeling lightheaded, breathing difficulties, fast heartbeat, clammy skin, confusion, or fainting. You’ll be asked to stay in the clinic for 20 minutes after the injection to monitor for any reactions.
Spinal Cord Damage
Spinal injections don’t target the spinal cord directly, so the risk of spinal cord damage is very low. However, spinal cord injury can occur indirectly due to chemical irritation, bleeding (blood clot), or reduced blood flow. The rate of spinal cord injury is estimated at around 1 in 150,000.
Worsening Pain or Paralysis
In extremely rare cases, spinal injections can lead to a worsening of pain or even paralysis. This may be due to complications after an infection, such as arachnoiditis. The rate of these complications is very low, estimated between 1 in 50,000 to 1 in 150,000.
Summary of Risks
Common side effects (<10%):
- Mild bruising or bleeding at the injection site.
- Temporary changes in sensation or weakness in the affected leg/arm (usually resolves in a few hours).
- Vasovagal reaction (temporary dizziness or fainting).
- Failure to achieve pain relief.
- Steroid flare (temporary increase in pain).
Rare But Serious Side Effects (<1%):
- Severe allergic reaction (anaphylaxis).
- Headache.
- Infection.
- Facial flushing.
- Skin discoloration or fat reduction at the injection site.
- Slightly increased blood sugar levels (if you are diabetic).
- Irregular menstrual cycle.
Extremely Rare Side Effects (<0.1%):
- Permanently worse pain.
- Paralysis.
- Blindness.
- Hiccups
- Nerve or spinal cord injury.
How to contact us
If you have any questions regarding the information contained in this leaflet, please call 02074823875 or email injections@complete-physio.co.uk and we will arrange for one of our clinical specialists to speak with you.
Frequently Asked Questions (FAQs)
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What is a facet joint injection?
A: A facet joint injection is a minimally invasive procedure where local anaesthetics and steroid medication are injected into and around a facet joint. The injection aims to numb the nerves for immediate pain relief and reduce inflammation for longer-lasting relief.
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When is a facet joint injection recommended?
A: Facet joint injections are typically recommended when conservative treatments like physiotherapy and over-the-counter pain medication have not been effective in relieving pain and irritation from the facet joints.
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What should I expect during the procedure?
A: The procedure involves lying down in a position that exposes the area needing treatment. An antiseptic is used to clean the skin, followed by a local anaesthetic to numb the area. Ultrasound guidance helps the doctor to accurately place the needle into the affected facet joint and inject the medication. The process takes approximately 20-30 minutes, and patients are monitored for up to 1 hour afterward.
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Why is ultrasound guidance used for the injection?
A: Ultrasound guidance is used to accurately see the area that needs to be injected, ensuring precise needle placement. This method increases the effectiveness, accuracy, and safety of the injection.
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Is the injection painful?
A: The injection may be uncomfortable, but this generally resolves quickly. Local anaesthetic is used to minimise pain, although some pressure or a mild burning sensation may be felt during the injection. Soreness around the injection site may persist for a few days.
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What should I do after the injection?
A: After the injection, rest in the waiting room for 20-30 minutes before leaving the clinic. Avoid strenuous activities on the day of the procedure and refrain from driving for 24 hours. Most patients return to normal activities within a few days.
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What are corticosteroids?
A: The injection includes corticosteroids, which are anti-inflammatory medicines used to treat various musculoskeletal injuries and conditions. They help reduce pain and swelling in the facet joint and around the nerve.
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Are there any risks associated with the injection?
A: Common side effects include mild bruising, swelling, and temporary changes in sensation. Rare but serious side effects include infection, spinal cord damage, allergic reactions, and worsening pain or paralysis. Always follow up with medical professionals if you experience any severe symptoms.
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How effective are facet joint injections?
A: Approximately 65% of patients experience good pain relief following a facet joint injection. However, the effectiveness varies from person to person, and the benefits may not always be long-lasting.
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Can I have multiple injections?
A: Whether additional injections are needed depends on your response to the first one. If the first injection provides good pain relief, a repeat injection may be considered if symptoms return. Medical guidelines recommend a maximum of three injections in the same area within a 12-month period.
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What benefits can I expect from the injection?
A: Benefits include reduced inflammation and pain, improved mobility, and confirmation of the pain source. The injection provides a “window of opportunity” for engaging in rehabilitation, leading to better symptom management and long-term improvement.
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What are the contraindications for the injection?
A: Contraindications include systemic infections, skin infections over the injection site, bleeding disorders, allergies to the medication, progressive neurological disorders, and uncontrolled diabetes or heart disease, among others. Always provide a full medical history to ensure safety.
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Do I need an MRI prior to a spinal injection?
A: Before undergoing a facet joint injection, it is essential to have an up-to-date MRI scan. An MRI provides detailed images of your spine, allowing your doctor to accurately assess the condition of your facet joints and surrounding structures. This imaging is crucial for determining the exact location and severity of the inflammation, which in turn helps in planning the most effective treatment strategy. Without a recent MRI, there is a risk of targeting the wrong area or missing an underlying condition that could affect the success of the injection. Ensuring that your MRI is current allows your healthcare provider to deliver the best possible care tailored to your specific needs. If you have any concerns or need further information about the procedure, please don’t hesitate to contact us.