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Lumbar Facet Blocks

What are facet joints?
Facet joints link the bones of the spine together in the posterior or back part of the spine. Two facet joints are present at each spinal segment. They are named for the spinal bones that they connect. For example, in the neck or cervical spine the facet joints between cervical #5 and cervical #6 are called C56. Likewise, in the lower back the facet joints between lumbar #5 and the sacrum are called L5 S1. Because there are two joints per level, there is a right and left joint.

What is the function of the facet joints?
The facet joints are important in restricting the motion of the cervical and lumbar spine. They allowed twisting, flexion and extension motions.

Why do facet joints cause pain?
Facet joints are possible sources of neck pain and lower back pain. The facet joint is innervated by a small nerve that branches out from a spinal nerve. Facet joints have been demonstrated to cause pain in studies in which healthy volunteers were subjected to injections of normal saline into the joint. Trauma, arthritic changes can cause the release of pain generating substances which sensitize nerve endings located in the joint.

What are some of the signs and symptoms of facet joint pain?
For patients with facet joint pain from the lower back, complaints usually consist of pain or tenderness in the lower back slightly over to one or both sides, pain with lower back extension, pain with twisting, radiation of pain to the buttocks or back of the thighs. For patients with facet joint pain from the neck, complaints are typically based on segment or level involved. Depending on the level involved, patients may have neck pain, headaches, shoulder pain, or scapular pain.

Does an x-ray or other test determined whether or not a facet joint is causing pain?
X-rays do not determine whether a facet joint is causing pain. However, x-rays may point out abnormalities such as osteoarthritis that may be significant in causing pain. A series of diagnostic blocks with local anesthetic are the only way to reliably determine whether in fact the facet joints are a source of pain.

What is a facet joint block?
A facet joint block involves the injection of a substance into or next to the facet joint. Typically, in a diagnostic block, local anesthetic is used. In most cases a corticosteroid is also injected. Radiographic control is mandatory in accurately and safely placing the needle. The purpose of facet joint blocks is twofold. Initially, it is a diagnostic block. If the patient receives 50% or greater pain relief for at least 2 hours, there is an increased likelihood that the facet joint is important in the patients pain syndrome. The block is then repeated to confirm the diagnosis. The second purpose of the facet block is to reduce pain. Corticosteroids can help reduce the pain secondary to inflammatory substances that sensitize nerve endings.

Potential risks and complications

As with all invasive medical procedures, there are potential risks and complications associated with facet joint injections. However, in general the risk is low, and complications are rare. Potential risks and or complications that may occur from a facet joint injection include:
  • Allergic reaction. Usually an allergy to x-ray contrast or steroid; rarely to local anesthetic.
  • Bleeding. A rare complication, bleeding is more common for patients with underlying bleeding disorders.
  • Infection. Minor infections occur in less than 1% to 2% of all injections. Severe infections are rare, occurring in 0.1% to 0.01% of injections.
  • Worsening of pain symptoms
  • Discomfort at the point of the injection
  • Nerve or spinal cord damage or paralysis. While very rare, damage can occur from direct trauma from the needle, or secondarily from infection, bleeding resulting in compression, or injection into an artery causing blockage.
In addition to risks from the injection, some patients will experience side effects from the steroid medication, such as:
  • Transient flushing with a feeling of warmth ('hot flashes') for several days
  • Fluid retention, weight gain, or increased appetite
  • Elevated blood pressure
  • Mood swings, irritability, anxiety, insomnia
  • High blood sugar-diabetic patients should inform their primary care physicians about the injection prior to their appointment
  • Transient decrease in immunity
  • Cataracts-a rare result of excessive and/or prolonged steroid usage
  • Severe arthritis of the hips or shoulders (avascular necrosis)-a rare result of excessive and/or prolonged steroid usage
This information was provided by Milwaukee pain clinic.
P.O. Box 290
840 Cook Road Hastings, MI 49058
Phone: (269) 945-9529 or 800-596-1005 FAX: (269) 945-9580