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Lumbar facet injections: The operation

Lumbar facet injections: The operation

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If you are considering having lumbar facet injections or have a procedure planned, it is important to know all you can about it. This includes:

  • why you need this procedure
  • what it will be like
  • how it will affect you
  • what risks are involved
  • any alternatives.

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

Submit a request for further information, a quotation or indicative cost. Your enquiry will be forwarded to up to 3 private healthcare providers. They will respond directly with further information.

Get a quote for a private facet joint injection >

What is the problem?

You have inflamed facet joints in your back. Pain may be felt in your lower back and may be worse on holding a fixed position for any length of time. This pain can also be worse when you extend the spine, when you straighten up from tying your shoelace, for instance. Keeping on the move usually reduces the pain. Sometimes the pain may spread to your buttocks, hips, groins, or down to your knee. This is called referred pain.

What is a facet joint?

Facet joints are pairs of small joints that hold the bony blocks (the vertebrae) of the spine together. As a result of injury, or simple wear and tear, these joints can become painful.

The facet joint is a structure that does two things. It helps keep the spine straight and firm to hold the weight of your upper body. At the same time it allows limited movement so that you can bend, stretch and rotate.

What are facet joint injections?

Injections into the facet joints are used to treat pain in that area. The injections are usually given into the lining of the joints where there is a soft membrane called the synovium. The synovium can become inflamed and cause pain. This pain can lead to muscle spasm or tightness, which can produce even more pain.

A facet joint injection can target a painful area. The injection bathes the joints in local anaesthetic and steroid solution. Only a small amount of steroid is needed and it will not cause any of the side effects sometimes associated with taking steroid tablets. They are not the same kind of steroids that athletes may take. This steroid injection relieves pain and inflammation. Pain from inflamed joints can be treated and the muscles made to relax and work properly again.

Often, facet joint injections reduce pain and improve mobility for a period of weeks or months, only for the pain to return. If the pain reduction from facet joint injections is worthwhile and useful then facet joint denervation is a way of making the benefits last much longer, perhaps up to several years. There is a separate information leaflet for facet joint denervation within this series.

What has gone wrong?

You have suffered general wear and tear (degeneration) or damage from injury to the facet joints at the base of your spine. When the joints are inflamed, the nearby muscles become irritated and go into spasm or cramp. Movement is then reduced.

The aims

The aim of the procedure is to reduce the inflammation of the joints. This reduces the low back pain you have. If the pain usually spreads to your buttocks, hips, groins and knees it should also be reduced.

The benefits

Your pain should be reduced and you should be able to move around more easily. The physiotherapist will show you exercises to help prevent the problem happening again. If successful, this treatment can avoid the need for surgery.

Are there any alternatives?

By the time that you have the facet joint injections you should have already tried other simpler treatments. These include rest, painkilling and anti-inflammatory tablets and physiotherapy with exercise.

You may also have tried a transcutaneous electrical nerve stimulation (TENS) machine for your pain. This works by sending soothing electrical pulses across the surface of the skin and along the nerve fibres. These pulses prevent pain signals reaching the brain. They also stimulate your body to produce higher levels of its own natural painkillers, called endorphins.

What if you do nothing?

If you do nothing there are several things that may happen:

  • With time and rest the inflammation and pain may settle on its own
  • The pain and difficulty in moving may remain the same
  • The pain may increase and spread to other parts of your spine
  • Your posture may get worse, making walking, sitting and even sleeping more difficult

Who should have it done?

The following groups of patients should have the procedure done:

  • Patients with low back pain caused by painful facet joints
  • Patients with low back pain that has not settled with other treatment

Who should not have it done?

Each patient has the final decision on whether to proceed or not. If you are unhappy about the procedure for any reason you should not continue.

There are specific medical situations when facet joint injections should not be done and they are as follows:

  • When a patient is on medication that prevents blood from clotting, such as warfarin. This would lead to more bleeding than normal. It may be possible to stop the medication a few days before the procedure. This will need to be discussed with your doctor
  • When a patient is suffering from an illness that prevents blood from clotting, such as haemophilia. This would also lead to more bleeding than normal
  • When there is infection of the skin over the site where the needle needs to be put in. This could lead to infection in the deeper tissues.
  • When a patient has noticed a recent worsening of their symptoms, especially weakness and loss of bladder or bowel control

Submit a request for further information, a quotation or indicative cost. Your enquiry will be forwarded to up to 3 private healthcare providers. They will respond directly with further information.

Get a quote for a private facet joint injection >

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