The procedure known as lumbar facet block is given for pain arising from the small joints in the back. The pain is usually caused by osteoarthritis and is often known as lumbago. It is different from the sharp pain of sciatica, which travels down the leg.

FACET JOINT INJECTIONS

Most backache related to facet joints can be treated successfully with a combination of exercise and improved posture. If your symptoms are very severe or difficult to treat you may need an injection. In this case, your doctor will inject a mixture of local anaesthetic into your inflamed facet joint. The treatment may be given in the doctor’s surgery and it may be slightly painful.
Results
These injections can be very successful but occasionally provide relief for only a few months. If you are suffering from severe osteoarthritis you may find that some of the newer techniques are beneficial. These include facet joint denervation by which the nerve supplying the joints are frozen or deadened with a radio frequency probe in order to reduce the pain felt. They are not major operations and referral can be made for this if necessary.
Facet joint injections take less than 15 seconds per joint and the results can be dramatic, the response can also help in the diagnosis.
If the injections provide only partial or temporary relief it may be necessary to use prolotherapy (A dextrose/glucose injection which strengthens the supporting ligaments of the lumbar spine). Information on this can be found on www.prolotherapy.me.uk and on our clinic web site

Treatments & Side Effects

The doctor will have discussed alternative treatments first. He may have talked about manipulation, acupuncture, TENS or alternative medications/injections but these may not be suitable for everybody.

You will be asked if you agree to the treatment. If you do, you will be asked to lie on your tummy under an X-ray machine. Identified joints may then be injected. The X-rays used are a much smaller dose than you would receive if you had a normal back X-ray.

Local anaesthetic is used so it is not an excessively painful procedure, patients are rarely sedated. Being awake is important as we need to know which joint is tender when the needle comes into contact with it. For short-term relief and diagnostic purposes, only anaesthetic need be injected. Adding a long-acting cortisone however, can sometimes result in several months relief. This is not the same as taking steroids for long periods, as in rheumatoid arthritis.

Risks

It is important that you do not drive yourself home, although you may feel perfectly able to. Anything other than the most minor of injections can impair your reflexes and this could cause an accident.

Sometimes, as a result of local anaesthetic reaching the neighbouring nerve roots that supply the legs, there is a feeling of numbness or weakness in one or both legs. This always wears off after a few hours. If this does happen, you must have help getting about at home or, preferably, lie down until the feeling returns. You might not feel any
benefit for the first day or two and some people feel worse temporarily for a few days. This may be due to bruising or soreness near to the injection site.

Some people do experience a few days of ‘hot flushing’. However, most people have no significant side-effects from
these single dose cortisone injections.

After Care & Benefits

The diagnosis is confirmed and the pain relief should allow you to gradually increase your activities. It is important that you do not immediately take up unaccustomed exercise until your muscles have had time to acclimatise to it. It is suggested that you start exercising in a mild fashion, taking two walks a day but limiting the distance and time to the level that you know you can manage easily.

You should be able to reduce your drug intake, sleep should be improved and there should be improvement in your posture.

Useful Addresses

If you have any questions please ask a member of the nursing staff who will be happy to help you. You may find other useful information at:
www.backcare.org.uk or www.britishpainsociety.org

Frequently Asked Questions

WHAT IS CORTISONE?

Cortisone is a powerful anti-inflammatory medicine which reduces inflammation around the nerve tissue and can break into the cycle of entrapment and swelling. This reduces pain, numbness, weakness.

IS THERE A LIMIT TO THE NUMBER OF INJECTIONS YOU CAN HAVE?

In any particular place in the body there is a natural limit of three injections in a 6 week period. Further injections are allowed in other places and at other times especially if they are effective. Your specialist will guide you.

WHAT COMPLICATIONS MAY OCCUR?

Hot flushes for 2 days.

Allergic reaction to any injection may occur in 1 in 7000 cases. This may just be a rash or a life threatening reaction. These will usually occur immediately and will be treated immediately. Most reactions are treated and cause no permanent harm.

Bleeding - Epidural Haematoma and resulting nerve damage is a very rare (1 in 7000) complication after a bleed around the nerves. This usually requires surgery to remedy.

Infection – Very rarely (1 in 7000). An Epidural Abscess or infection in other tissues can occur rarely. You should watch for signs of fever, redness, swelling and increasing pain. This can be treated with antibiotics or even surgery.

Spinal Fluid Leak – This causes a very bad headache, nausea/vomiting which goes away on lying down. This rarely lasts more than a few days.