FACET JOINT INJECTIONS Patient Information

Dear patient, Welcome to Hampshire Backs Service. We believe you will benefit from a facet joint injection to relieve your pain. This leaflet contains all the information you need to know about the procedure, possible risks and what will happen after the procedure. Yours Sincerely, Richard Harker & John O’Dowd Spinal Consultant Surgeons

WHAT IS A FACET JOINT? The spine is composed of 24 bones called vertebrae, which are block-shaped bones with rigid discs in between them. The neighboring vertebrae form several joints with each other and these are called facet joints. They are small joints at the back of the spine, which enable stability and movement. These joints can become painful as a result of degenerative changes, a back injury or mechanical stresses to the back. There are cervical (neck), thoracic (upper back) and lumbar (lower back) facet joints. WHAT IS A FACET JOINT INJECTION? Facet joint injections are used as a pain relief tool for people and the injection can help reduce pain, swelling and irritation. Injections are also a useful diagnostic tool as a means of identifying the site of your pain, whether it is coming from the facet joint or elsewhere. WHAT IS IN THE INJECTION? A mix of local anesthetic and slow-release steroids are used for the injections, which are injected into the joint or to the nerve that innervated the joint. This gives a combined effect of reducing the inflammation and irritation as well as pain relief. HOW DOES IT WORK? The mixture injected around the painful area can relieve pain for several weeks or even several months. Steroids are used worldwide in pain relieving injections and they work by reducing the inflammation around the nerves, which reduces pressure and pain. The local anaesthetic numbs the nerves for a period of time. The aim of the injection is to enable the patient to tolerate exercise and to rehabilitate their backs. SIDE EFFECTS AND RISKS: Immediately after the injection, your legs may feel tingly and heavy but this will wear off after a couple of hours. It is important to walk around until your legs feel completely normal. If you have diabetes, you ay need to make some changes to your medicine or diet on the day of the procedure. There are very small and infrequent risks associated with a nerve root injection. These may include temporary discomfort, temporary numbness in legs, allergic reaction to the medication, injury to the nerves, infection and bleeding.

Photo  credit  @NASS  

HOW TO PREPARE:

• You will attend a Pre-assessment clinic a few weeks before your injection where a thorough medical assessment will be carried out (heart, urine and blood tests)

• You can ask your consultant any questions • Arrange for someone to drive you to and from the hospital • If you are taking a taxi you will need someone to accompany you • You will go home the same day • If you have a cold or flu, inform your doctor. The procedure may need to be rescheduled • If you need to cancel the appointment, do it as soon as possible • On arrival you will be welcome by a nurse who will show you around the ward • You will be asked to sign/re-sign the consent form • If you are female you will be asked to reconfirm you are not pregnant • Before the injection you will get changed into a hospital gown

THE PROCEDURE: A small needle may be placed in a vein at the back of your hand in order to give you fluid or medicines if necessary. You will be placed in a lying position on your front (for lumbar injections) or on your side or back (for cervical). The consultant will feel around your back to identify the painful levels and will ask you where your pain is. You will be given sedation to make you feel sleepy during the injection. The painful area will be cleaned with anti-septic solution. X-rays will be used to guide the correct placement of the needle into the joint. The needle is very thin and you may feel just little pinprick pain. The procedure will be performed at the operating theatre and takes 15 to 20 minutes. AFTER THE PROCEDURE: You will be able to get up normally after the procedure and walk unaided but you will be required to stay in the hospital 2-3 hours after the procedure. It is normal to feel more pain for a few days because the injection may take 10 days or more to relieve your pain. It is advised that you rest for the next 24 hours and during this time you should not drive a car, drink any alcohol, operate equipment or sign any legal documents. You should continue taking your usual medication and the next day you can take a bath or shower to remove any plasters. EXERCISE: Mobilize gently and carry out simple exercise but avoid any strenuous exercise for a few days. You will be able to return to your normal exercise routine within a week. In fact, it is advised that you take up exercise if you haven’t done so before. The injections can be effective in breaking the pain cycle and allowing you to rehabilitate in order to restore your health and fitness. This is extremely important in order to minimize the chances of such back pain reoccurring. It is also advised to keep a healthy body mass index as carrying extra weight is associated with poorer fitness, reduced strength, endurance and may increase the chances of getting back pain in the future.

WHAT TO EXPECT? The effectiveness of facet joint injections varies from person to person. Some people feel immediate pain relief that can last several months or years. For others, there is limited benefit following the procedure. No treatment is guaranteed to work for all people however it is always important to start or continue with a regular exercise routine to strengthen your body, improve your fitness and move better. Your physiotherapist will be able to advise you regarding the most appropriate exercises for you. The most effective long-term improvement is likely to be achieved by including exercise and education. EMERGENCY INFORMATION: If you develop any of these following symptoms, contact your GP immediately:

• Severe headaches or pain • Fever or chills • Redness and swelling around the injection site • Loss of bladder or bowel control • Numbness in the saddle area • Numbness in legs or arms • Weakness in legs or arms • Pins and needles in legs or arms

CONTACT: If you have any problems or questions call your GP or phone the ward: 01256313681 For more information about back pain look at: www.hampshirebacks.co.uk