Cervical Facet Injections

The cervical facet joints are important for cervical spinal stability and for providing motion of the neck. Unfortunately, they can easily become injured or arthritic, leading to localized joint pain or pain along the spinal nerve that exits the lateral spinal canals. This kind of pain leads to radicular pain, which can be on the arms or upper chest.

When the facet joint becomes injured or arthritic, the choices of pain relief might include surgical fusion, pain medication and facet joint infection. The advantages of facet joint injection include short recovery time after the procedure and the lack of addiction potential, as would be seen with some pain medications.

A facet joint injection must be done by a physician qualified and well-practiced in doing this type of injection. A cervical facet joint injection begins with an IV placed in order to provide sedation or relaxation to the patient. Once this is accomplished, the doctor uses x-ray technology to guide the needle into the middle of the facet joint. Often a small amount of contrast dye is inserted into the joint space and x-ray fluoroscopy verifies the needle’s position.

When the needle is properly placed as verified by x-ray, a mixture of local anesthetic and cortisone is given to the patient through the same needle. If the correct joint has been injected, there is often immediate relief because the local anesthetic has kicked in and relieves the pain in the joint. This unfortunately wears off after a few hours. Within 1-3 days, the cortisone begins to work so there is usually relief after that.

The relief from a cervical facet injection lasts about 3 months. After that, another injection can be done. Cortisone has some systemic effects on the body so that repetitive injections with cortisone are not recommended.

The indications for cervical facet joint injections include osteoarthritis of the facet joint, injury to the facet joint, narrowing of the spinal canal at the level of the cervical joint or radicular pain from a narrowing of the spinal facet joint canal. Narrowed canals can result in a “pinching” of the nerve. Fortunately, cortisone can shrink the swelling of the nerve so there is better nerve function, at least for a period of time. The pain involved in facet joint injury can be in the neck, shoulders, arm or chest.
The biggest risk of having a cervical facet injection is that the facet joint is not the right one or is not the problem at all. The joint is injected with drugs that actually do no good to help the problem and can have side effects all their own. Another risk is infection inside the joint, which can be difficult to treat. A blood vessel can inadvertently be injected or punctured with a needle, leading to bleeding or the intravenous injection of cortisone that is not meant to be an intravascular drug.

While the injection itself takes only a few minutes, it takes up to an hour to do the procedure, so it’s necessary to lie still for up to 30 minutes after the injection. It is after that that the doctor will ask the patient to reproduce the pain to see if it has been relieved.

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