The spine is made up of bones (vertebrae) joined together by the discs at the front and small joints called facet joints at the back. The facet joints can become arthritic and painful.
If surgery is to be undertaken, it is clearly essential to identify as accurately as possible the source of the pain. Often this is obvious on the scans and X-rays but sometimes more than one potential cause is found or the cause is not entirely clear. In such situations further, more invasive investigations including diagnostic facet joint injections can be helpful.
The procedure is also used to treat back pain caused by facet joint disease.
Facet Joint injection involves the insertion of a needle into the facet joints using X-ray control. The joint is injected with contrast to confirm correct positioning. Local anaesthetic is injected to see if the pain resolves which offers evidence of the facet joints being at least in part the pain source.
A long acting steroid or other anti inflammatory medicine is usually injection to see if longer term resolution of symptoms can be obtained.
Sedation is given during facet joint injection. The injection may cause some discomfort or but this is usually short lived.
After the operation you will be encouraged to mobilize as soon as possible with the assistance of physiotherapists and nurses. Once mobile enough to manage at home you can be discharged.
It is important to keep a record as to whether your pain is worse, the same, or better in the hours and days after your facet joint injection.
An outpatient appointment will be arranged.
Facet joint injection is a test and a treatment for your symptoms. You should get back to normal function very quickly after the procedure. The procedure is usually done as a day case.
In order to monitor the results of surgery you will be asked to complete outcome questionnaires from time to time.
Most patients do not suffer any adverse problems. Occasionally complications do occur and can require further treatment.
Nerve damage is rare during facet joint injection. If it occurs it can cause areas of numbness, pins and needles and weakness. Neuralgic pain can also be troublesome.
Cauda equina syndrome is very rare and occurs when the nerves to the bowel and bladder are affected. Any numbness around the bottom or problems with passing stool or water should be reported immediately.
Scar tissue can form around the nerve root tethering the nerve causing ongoing pain. Occasionally further surgery is required to free up the nerve.
Infections can occur in the wound and rarely deep in the joint. These can be treated with antibiotics but occasionally require surgical cleaning and debridement.
Damage to the lining of the nerve root (Dura) can result in a leak of fluid (csf).. Rarely the leak persists and has to be repaired surgically.
Spasm can occur causing a short period of troublesome pain aggravating previous symptoms. This is treated if necessary by antispasmodic medication.
Anaesthetic complications will be explained by your anaesthetist.
Please be assured that every effort is made to avoid the complications listed and any others which can very rarely occur.
If you have any questions or wish to discuss things further please ask at any time. It is important that you have all the information you require about your procedure, and we will assist you in every way possible.
MR ANDREW HOWARD
Consultant Spinal and Orthopaedic Surgeon
Ref No FJI0205