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Cervical facet injections

If you are considering having cervical facet injections, it is important to know all you can about them. 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.

 

 

What is the problem?

You have painful facet joints in your neck. Pain may be felt in your neck and may be worse when holding a fixed position for any length of time. This pain can also be worse when you extend your spine, for instance, when you look up to the sky. Looking over your shoulder, as when reversing a car, may also cause more pain. Keeping on the move usually reduces the pain. Sometimes the pain may spread to the back of the head, the shoulder or down towards the shoulder blade. This is called referred pain.

 

What is a facet joint?

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

Cervical facet injections

The facet joint is a structure that does two things. It helps keep the spine straight and firm to hold the weight of your head. At the same time it allows limited movement so that you can nod, look up and look over your shoulder.

 

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 synovium. The synovium can become inflamed and cause pain. This pain can lead to muscle spasm or tightness in the neck, which can produce even more pain.

 

By targeting the painful area, facet joint injections bathe 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. By doing this, pain from inflamed joints can be treated and the muscles made to relax and work properly again.

 

Often, facet joint injections reduce your pain and improve your mobility for a period of weeks or months, only for the pain to return. If the pain reduction from the facet joint injections is worthwhile and useful to you, then facet joint denervation could be done. This is a way of making the benefits last a lot longer, perhaps up to several years. There is a separate information leaflet for cervical facet 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 top of your spine. These joints often become painful after a whiplash injury. When the joints are inflamed or damaged, 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 your joints. This reduces your neck pain. Pain that usually spreads to the back of your head, your shoulder or down towards your shoulder blade 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 neck pain caused by painful facet joints

  • Patients with neck pain that has not settled with other treatments

 

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

 

Author: Dr Sean White FRCA. Consultant in pain and anaesthesia

© Dumas Ltd 2006

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