Intra-Facet Steroid Injection

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Facet joints are small joints throughout the spine that provide stability and help guide movement. Like other joints in the body, they can become painful as a result of arthritis, injury, or mechanical stress. Pain tends to stay in the neck and back rather than extend all the way down the arms and legs though on occasion there can be minor radiation of pain into the upper aspect of extremities, shoulders, and can even cause headaches. 

 Pain in facet joints can originate from arthritis and inflammation as noted above. An intra-facet injection uses xray guidance a small needle to place steroid medication within the joint space much like someone that may have steroid injected into a knee, hip, or shoulder joint. A combination of local anesthetic and steroid is used with the local anesthetic acting as numbing medication for immediate relief and the steroid being a potent anti-inflammatory medication to provide long lasting relief.  

It is difficult to predict the response for someone's first intra-facet injection though most commonly patient’s will have 3-6 months of relief following the injection. There are some that have a shorter or no response and others that have a more prolonged response. Add an answer to this item.  

If pain returns, we can repeat the procedure pending the duration of relief that was achieved. Alternatively can move forward with trial of the MBB/RFA procedure series. 

As with any procedure it is not without risks. With placement of a needle through the skin, there is always concern for infection or bleeding. Notify your doctor if you are taking any blood thinners/aspirin/plavix or have an active infection. Given the proximity to the spine, there is risk of nerve injury or damage though this is low. Patients with diabetes should monitor their blood sugar closely as steroids can cause it to increase. Generally, the biggest risk is some mild post procedure soreness which typically resolves in 24 hours. Stretching, ice/heat, and anti-inflammatory medications (if medically able) can help with this. Risk that the procedure makes things worse or does not offer improvement is possible. 

A medial branch block (MBB) and radiofrequency ablation (RFA) is similar in that it targets facet joint pain though different in that it targets small nerves that supply sensation to the joint. It is a multi step process with the first 1-2 quick injection diagnosing the painful area and the 3rd procedure applying heat to “burn” the medial branch nerve which offers longstanding relief of ~1-2 years for most people.