To inject medication for chronic pain relief, your doctor may recommend a facet joint block. This minimally invasive procedure uses fluoroscopy or computed tomography (CT) imaging to help guide a needle to deliver a dosage of local anesthetic or another numbing medicine directly to a facet joint.
What Is a Facet Joint Block?
Facet joints can be found on both sides of each vertebra along the neck and back. They are essential for motion, support and stabilizing your spine. Unfortunately, conditions like arthritis lead to pain or inflammation within these joints.
To inject a numbing or pain-relief medication into a facet joint, a radiologist uses fluoroscopy or CT technology and a thin, hollow needle 3.5 to five inches long, based on your body size. To take images, fluoroscopy uses a traditional X-ray tube while for a CT scan, the patient passes through a large, box-shaped machine with a tunnel going through the center.
When images are taken, the patient lies on a narrow table that passes through the tunnel. In the process, an X-ray tube and detectors located on a gantry rotate around you and gather information. In a separate room, a computer interprets the data to display images on a monitor.
Once the ideal place for injection is identified via imaging, a doctor inserts the needle through the skin to the facet joint. Contrast material may also be injected. The doctor then injects a local anesthetic or anti-inflammatory medication into the joint.
Who Should Have This Procedure?
Doctors may recommend a facet joint block to reduce inflammation, provide long-term relief, help the patient better manage physical therapy and other rehabilitative exercises, or determine the precise cause of back or neck pain. As one benefit, radiation does not remain in the body post-procedure.
While a facet joint block offers immediate relief, it comes with a handful of risks and therefore may not be ideal for certain patients. These risks include:
- A low chance of infection
- Allergic reaction to the contrast material or anesthetic
- Bleeding, especially if the patient uses blood thinners or has a bleeding disorder
- Nerve or spinal cord damage or paralysis due to the needle or subsequent infection
- A low risk of radiation exposure, which may be an issue if the patient is pregnant
Preparation
Prior to the procedure, your doctor may ask you to get bloodwork done to determine if your blood clots normally. You’re also advised to discuss any medications and supplements you’re currently taking, including those that contain iodine, any over-the-counter pain relievers and certain blood thinners.
Discuss any allergies, especially to anesthesia and contrast dye, and mention any recent illnesses or medical conditions, including if you are or may be pregnant.
Your doctor may provide further instructions:
- You may be asked to stop taking aspirin, NSAIDs or blood thinners before the procedure.
- You may be told to not eat or drink anything for at least eight hours before the procedure, as contrast material may be used during the exam.
- If you have a history of allergic reactions to contrast material, you may be prescribed medication to take ahead of time.
- As metal objects affect imaging, you should leave all jewelry, glasses, hairpins, dentures, hearing aids, piercings and other metal objects outside.
- Make sure you have someone available to drive you home after the procedure.
A facet joint block is usually done on an outpatient basis without sedation. If the doctor determines sedation is needed, you will be given an IV. As the procedure begins:
- The doctor or technologist will ask you to lie face down on the exam table. Monitors for your heart rate, blood pressure and pulse may be connected.
- The area where the needle will be inserted will be sterilized before it’s covered with a surgical drape. The doctor overseeing the procedure will then numb the area with a local anesthetic.
- Using the guidance of X-rays or CT scans, the doctor inserts the needle into the skin toward the facet joint. At this point, a small amount of contrast material will be injected. Doing so ensures the needle has entered the joint.
- After the doctor confirms this information, a mixture of an anesthetic and an anti-inflammatory will be injected into or near the joint. Usually, patients receive lidocaine with a steroid or cortisone. After, the needle is withdrawn.
- Pressure will be applied before a bandage is put over the skin. The incision is not deep or wide enough to warrant sutures.
- While the imaging and injection take roughly 30 minutes, patients often need to stay in an observation area to assess the medication’s effects.
- Following the procedure, any IV used will be removed.
Over the next few days, patients may feel some soreness around the injection site. It’s recommended you ice the area, although your doctor may also prescribe a pain medication. Patients are advised to avoid strenuous activities for 24 hours after the injection.
In some cases, your pain level may feel as like it’s increasing. However, this sensation is only temporary, often occurring after the local anesthetic wears off and before the cortisone kicks in. The anti-inflammatory medication may also have a few side effects, although these wear off after a few days.
The radiologist overseeing the procedure will let you know if the injection was successful. If you experience some relief, it may be recommended you undergo this procedure multiple times a year for pain management.
Has your doctor recommended a facet joint block? Contact us to make an appointment today!
