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Lumbar Facet Joint Injection
Paul Dreyfuss, M.D.
What are lumbar facet joints
and why are facet joint injections helpful?
Lumbar facet joints are small
joints a little larger than the size of the thumb nails
located in pairs on the back of the spine. They provide
stability and guide motion in the low back. If the joints
become painful they may cause pain in the low back, abdomen,
buttocks, groin or legs.
A facet joint injection serves
several purposes. First, by placing numbing medicine into
the joint, the amount of immediate pain relief experienced
will help confirm or deny the joint as a source of pain.
Additionally, the temporary relief of the numbing medicine
may better allow a chiropractor or physical therapist to
treat that joint. Also, time release cortisone (steroid)
will help to reduce any inflammation that may exist within
the joint(s).
What happens during the
procedure?
The patients are placed on
the X-ray table on their stomach in such a way that the
physician can best visualize these joints in the back using
x-ray guidance. The skin on the low back is scrubbed using
2 types of sterile scrub (soap). Next, the physician numbs
a small area of skin with numbing medicine. This medicine
stings for several seconds. After the numbing medicine has
been given time to be effective, the physician directs a
very small needle, using x-ray guidance into the joint.
A small amount of contrast (dye) is injected to insure proper
needle position inside the joint space. Then, a small mixture
of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid)
is injected. One or several joints may be injected depending
on location of the patients usual pain.
What happens after the procedure?
Immediately after the procedure, the patient will get up
and be asked to ambulate try to imitate something that would
normally bring about their usual pain. Patients are then
asked to report the percentage of pain relief and record
the relief experienced during the next week on a post injection
evaluation sheet ("pain diary"). This will be
given to the patient when they are discharged home.
The leg(s) may feel weak or
numb for a few hours. This is fairly uncommon, but does
occasionally happen. The patient may be referred to a chiropractor
or physical therapist immediately after the injection(s)
while the numbing medicine is still working for manipulation
or massage.
General Pre/Post Instructions
Patients can eat a light meal
within a few hours before the procedure. If a patient is
an insulin dependent diabetic, they must not change their
normal eating pattern prior to the procedure. Patients may
take their routine medications. (i.e. high blood pressure
and diabetic medications). Patients should not take pain
medications or anti-inflammatory medications the day of
their procedure. Patients have to be hurting prior to this
procedure. They may not take medications that may give pain
relief or lessen their usual pain. These medicines can be
restarted after the procedure if they are needed.
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SpineUniverse
Editorial Board Comments
“While
facet joint injections are a commonly performed procedure,
there is, as yet, little scientific evidence that
they are better than a placebo at curing back ailments
or providing accurate direction of surgical treatments.”
Todd
Albert, M.D. - Editorial
Board, SpineUniverse.com
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