What is a facet joint and why do we do injections?

Facet joints are small joints at the back of the spine (back bone.) They allow us to twist, turn and bend. Facet joints are exposed to a lot of stress or work as they allow the spine to move. This can lead to wear and tear changes, irritation, inflammation and arthritis. We first try to treat this with conservative measures, such as heat / cold, physical therapy and medications. Most patients respond positively to this treatment. However, if pain persists, we may offer a facet joint injection.

How Are Facet Joint Injections Done?

Facet joint injections are often done in two stages. The first injection is done to confirm the diagnosis, to see if the facet joint is the cause of the pain. It can also treat the pain. A small needle is placed and medication is injected around a small nerve close to the joint that is causing pain or into the joint itself. The medications commonly used are a numbing medication (local anesthetic such as lidocaine) and a steroid medication which is a very strong anti-inflammatory medication (such as cortisone.) Pain relief can last from hours to months and is usually followed by physical therapy.

A second procedure may be done, which can provide a more long-term solution depending on the results of the first injection. The second injection temporarily disconnects the nerve innervating the joint and causing the pain. The nerve then regrows very slowly, typically in one to two years. During this time, patients are generally pain free. At Cincinnati Children's we provide the first type of injection and would refer your child to an adult facility if the second type of procedure is needed, which is not very often.

What Happens the Day of the Procedure?

1. You will see your pain doctor in the few weeks before the procedure to review the procedure’s risks, benefits and alternatives.
2. You and your child will check into Same Day Surgery on the 3rd floor, B building unless otherwise instructed.
3. Your child will be asked to change into a hospital gown.
4. Most patients lie on their stomach for the procedure.
5. Your child may have an IV started and sedation administered in the procedure room. Your child's skin will be cleaned with a special cleaning solution and local anesthetic (numbing medicine) will be given using a tiny needle.
6. X-rays and special x-ray dye are routinely used to guide the needle to the proper position and to watch the medication as it is injected.
7. After the medication is injected, your child will be permitted to roll onto their back and be taken to the recovery room. We may ask your child to move in certain ways to test how well the injection is working.
8. You will be provided with follow-up instructions for your child when discharged.

What are the Complications of a Facet Joint Injection?

There are several possible complications; however, the risk is extremely low. These include but are not limited to:

• Infection
• Bleeding
• Nerve damage

What Should We Expect after the Injection?

You may find that your child's pain gets better from the numbing medicine for a few hours, then possibly worse for a few days until the steroids take effect. Your child's physician may order a small amount of pain medication for the first two days until the steroid medicine begins to work. The increased pain occurs because we are inserting a needle into an area that is already irritated and this causes more irritation. After the steroid begins to work, approximately three to six days after injection, we ask that you call our office or send a MyChart message to let us know how your child is doing. You can also call us with questions or concerns at 513-636-7768.

When to Call the Doctor

Call your child's doctor if the site of the injection becomes red or swollen or they develop a fever.