Lumbar Facet Joint Injection - Ipswich Hospital

Lumbar FacetJoint InjectionSpinal UnitTel: 01473 702032 or 702097Issue 2: January 2009

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When back pain originates from the facet joints, a specifictype of injection may reduce inflammation and providepain relief.The facet joints are the interlocking connections at the backof the spine. There is one to the right and left at each leveland they have a surface of cushioning tissue between them(cartilage). Just like any joint in the body, the facet jointscan become inflamed due to arthritis and be a source ofpain and stiffness, usually in the low back. Most people whosuffer from this problem typically complain that pain is mostpronounced first thing in the morning, decreases throughoutthe day and becomes worse again later in the day. The painmay also become worse with twisting movements of the spineor leaning back (extension).Model of the lumbar spine showingthe facet joints and nerve rootsBack viewSide viewL2DiscL2L3Facet jointsL3L4L5Spinal nerverootIliac crestL4L5Page 3

The facet joint injection consists of an anaesthetic with along-lasting steroid injected into the facet joint itself. Thisreduces the inflammation in the joint space. This can reducepain and other symptoms caused by inflammation such asnerve irritation. The facet joint injections are often used as adiagnostic tool to isolate and confirm the specific source ofthe patient’s pain.About the procedureThe injection is done under intravenous sedation (so you areasleep) and carried out with you lying on your stomach. Theskin on your back is cleaned with antiseptic solution and thenthe injection is carried out. Live x-ray is used as guidance todirect the needle into the facet joint capsule.Right L3 / 4 facet joint injection (back view)L2L3L4Position ofinjectionL5Page 4

Risks and complicationsFortunately there are very few risks associated with facet jointinjection. The most common side effect is discomfort, whichis temporary. Other very uncommon risks involve infection,nerve or dural injury (the membrane surrounding the nerves)or bleeding.Sometimes however, it is difficult to inject people due to thepresence of bony overgrowths at the tip of the joint, whichprevents the needle from entering.What to expect in hospitalImmediately after the injection you will be taken on your bedto the recovery ward where nurses will monitor your bloodpressure and pulse. Oxygen may be given to you througha facemask to help you wake up after the sedation. Onceback on the ward, you may have some discomfort whichthe nursing staff will help you to control with appropriatemedication. When you are fully awake you will be allowed toget out of bed.Going homeYou will normally be allowed home a few hours after yourinjection, when you and your physiotherapist are happy withyour mobility.Please arrange for a friend or relative to collect you, as drivingyourself or taking public transport is not advised for 48 hoursafter the sedation. A responsible adult should remain withyou overnight. If you are likely to require a hospital car pleasearrange this through your GP before admission.Page 5

WorkYou will need to be off work for at least 48 hours, or maybelonger if discomfort persists. The hospital can give you an offwork certificate or you can ask your GP.Follow-upWe will send you an appointment to return to clinic 6 – 8weeks after your injection. If you have any queries beforeyour follow-up date please contact the nurse specialist foryour consultant’s team.Contact numbersMr Hay’s secretary 01473 702751Mr Powell’s secretary 01473 702032Mr Sharp’s secretary 01473 702097Spinal nurse specialist 01473 702588Page 6