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The syndromes most commonly requiring Facet Injections include:

•  Spinal Stenosis
•  Herniated Disk
•  Sciatica
•  Spondylolysis

Procedure:

The facet joint of the spine is a moveable connection that connects one vertebra (bone of the spine) to another.  This
injection includes both a long-lasting steroid and an anesthetic (lidocaine, bupivacaine).  The steroid reduces the
inflammation and irritation and the anesthetic works to numb the pain.  The combination medicine then spreads to other
levels and portions of the spine, reducing inflammation and irritation.  The entire procedure usually takes less than 15
minutes.

The Facet Injections and the Epidural Steroid Injections (ESI) are very similar and differ in the location that they inject the
medicine.  In an ESI, the medication is injected into the epidural space whereas in the facet injections, it is injected directly
into the joint.


























Benefits:

The most important and greatest success achieved with the use of facet injections is the rapid relief of symptoms that
allows patients to experience enough relief to become active again.  With  this they regain the ability to resume their
normal daily activities that was not achieved with oral medications and physical therapy.

Another benefit to the use of facet injections is that it can be used as a diagnostic test to see if the pain is actually coming
from the facet joints. If your pain disappears with the injection then it is clear that the pain is originating from the joint, and
it has been shown that therapeutic lumbar facet joint nerve blocks with local anesthetic, with or without steroids, may be
effective in the treatment of chronic low back pain of facet joint origin. (Manchikanti  2007).  However, if your pain is
unresponsive then this gives your physician information that can help him in diagnosing your condition.

A large evidence-based practice guideline for the management of chronic spinal pain with interventional techniques was
developed by the American Society of Interventional Pain Physicians provide recommendations to clinicians and patients
in the United States.  IN regards to the facet injections they states that the accuracy of facet joint nerve blocks is strong in
the diagnosis of lumbar and cervical facet joint pain (Boswell 2007).


Risks:

With a minimal amount of risks, facet injections are considered an appropriate non surgical treatment for many patients
who suffer from back pain. The associated risks with this procedure involve misplacement of the needle, either advancing
the needle too deeply or positioning it incorrectly.  The outcome of the incorrect positioning of the needle can potentially
cause nerve damage, bleeding, infection, and a headache following the injection.  

As with any medication taken, there are always risks and potential side effects that may occur.  The other risks of the
facet injections may be directly caused by the actual medication given, however, the risk of developing these side effects
are much higher in a person taking oral corticosteroids.  Some of the potential side effects of the corticosteroid may
include elevated blood sugars, weight gain, arthritis, stomach ulcers, and transient decrease in the immune system.  All
patients before receiving a facet injection should be assessed by their physician about risk assessment for the procedure.



Outcome:

Lumbosacral injections have increased dramatically in the Medicare population from 1994 to 2001 and are becoming
even more popular today (Friedly 2007).  They are being used more frequently because they have provided very
successful results in the treatment of back pain.  

In research study a group of patients with back pain received facet injections and at 8 weeks of treatment 53% of people
reported improvement of their pain and by 6 months of treatment over 68%  reported the same (Anand 2007).  The
duration of pain relief varies from each individual but if the first facet injection provides relief then the procedure can be
repeated up to 3 times a year.


Articles:

Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a
randomized, double-blind controlled trial: clinical trial NCT00355914. Manchikanti L, Manchikanti KN, Manchukonda R,
Cash KA, Damron KS, Pampati V, McManus CD. Pain Physician. 2007 May;10(3):425-40 PMID: 17525777

Increases in lumbosacral injections in the Medicare population: 1994 to 2001 Friedly J, Chan L, Deyo R. Spine. 2007 Jul
15;32(16):1754-60 PMID: 17632396

Patients' response to facet joint injection. Anand S, Butt MS. Acta Orthop Belg. 2007 Apr;73(2):230-3 PMID: 17515236

Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Boswell MV,
Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB,
Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood
JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L; American Society of Interventional Pain
Physicians. Pain Physician. 2007 Jan;10(1):7-111 PMID: 17256025
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Facet Injections  
by Nicole Berardoni M.D, Paul Lynch M.D, and Tory McJunkin M.D

Facet injections are a minimally invasive no surgical treatment
that is used as treatment for many different causes of neck and
back pain.  It works by reducing the inflammation and irritation in
the facet joints of the spine that is causing you pain.
Book I  -  Pain Syndromes

Chapter 1     Low Back Pain
Chapter 2     Neck Pain
Chapter 3     Cancer Pain
Chapter 4     Headaches
Chapter 5     Spinal Stenosis
Chapter 6     Sciatica
Chapter 7     Arthritis
Chapter 8     Fibromyalgia
Chapter 9     Motor Vehicle Injuries
Chapter 10   Complex Regional Pain
Syndrome
Chapter 11   Vertebral Body
Fractures
Chapter 12   Hip and Leg Pain
Chapter 13   Diabetic Peripheral
Neuropathy

Book II  -  Interventional Procedures

Chapter 14   Epidural Steroid
Injection
Chapter 15   Facet Injections/Medial
Branch Blocks
Chapter 16   Radiofrequency Ablation
Chapter 17   Spinal Cord Stimulator
Implants
Chapter 18   IntraDiscal
Electrothermal Therapy (IDET)
Chapter 19   
Vertebroplasty/Kyphoplasty   
Chapter 20   Discography
Chapter 21   Percutaneous
Discectomy
Chapter 22   Occipital Nerve Block
Chapter 23   Sympathetic Block
Chapter 24   Stellate Ganglion Block
Chapter 25   Intrathecal Pump
Implants
Chapter 26   Caudal Steroid Injection
Chapter 27   Adhesiolysis
Chapter 28   Cervical Steroid
Injection
Chapter 29   Sacroiliac Joint
Injections
Chapter 30   Celiac Plexus Block
Chapter 31   Head and Neck
Procedures
Chapter 32   Joint Injections
Chapter 33   Continuous Catheter
Nerve Blocks
Chapter 34   Peripheral Nerve
Stimulation/Field Stimulation
Chapter 35   Disc Denervation

Book III   Other Treatments

Chapter 36   Medication Management
Chapter 37   Acupuncture
Chapter 38   Prolotherapy
Chapter 39   Botox
Chapter 40   Massage
Chapter 41   Alternative and
Complementary Medicines
Chapter 42   Exercise and Nutrition
Counseling
Chapter 43   Prayer
Chapter 44   Cognitive Behavioral
Therapy
Chapter 45   Group Therapy
Chapter 46   Biofeedback
Chapter 47   Chiropractic
Manipulations
Chapter 48   Vitamin Supplements
Chapter 49   Customized
Pharmaceutical Formulations
Chapter 50   Hormone Therapy

Frequently Asked Questions