Facet Injection

|Hide
Procedures Consult Mobile
Quick ReviewFull DetailsChecklist
Pre-ProcedureProcedurePost-Procedure
Help  |  Print
SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Facet syndrome
  • Facet arthropathy
  • Facet joint synovitis
CONTRAINDICATIONS
  • Systemic infection
  • Local skin infection at injection site
  • Bleeding diatheses
  • Allergy to injection materials
  • Severe foraminal stenosis
EQUIPMENT
  • Pain management table
  • Fluoroscopy unit
  • Povidone-iodine
  • Isopropyl alcohol
  • 22- or 25-gauge 3½-inch spinal needle
  • 0.75% preservative-free Marcaine
  • Nonionic contrast dye
  • 3-mL syringe
  • Corticosteroid of choice (optional)
ANATOMY
  • Facet joints: superior articular processes of the vertebra below and inferior articular processes of the vertebra above.
  • Synovial joint: articular cartilage, synovial fluid, and a joint capsule.
  • Facet joints "lock" the spinal column together.
  • Cervical facet joint innervation: medial nerve branch above and below that joint.
  • Lumbar facet joint innervation: dual innervation with medial nerve branches crossing the transverse processes below their origin.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
TECHNIQUES
  • Post-Procedure: Medial Branch Block Injection (Cervical Facet Joint)
  • Post-Procedure: Intraarticular Injection (Lumbar Facet Joint)
  • Post-Procedure: Medial Branch Block Injection (Lumbar Facet Joint)

Post-Procedure: Medial Branch Block Injection (Cervical Facet Joint)

POST-PROCEDURE CARE
  • Observe the patient for at least 15 minutes but allow them to walk immediately.
  • Instruct the patient to not drive home and avoid strenuous activities for 24 hours.
COMPLICATIONS
  • Infection
  • Local injection site pain
  • Bleeding
  • Nerve block/nerve damage
  • Allergy to injection materials
ANALYSIS OF RESULTS

A 2007 meta-analysis showed limited support for the efficacy of intraarticular cervical facet injections, moderate support for lumbar intraarticular facet joint injections, and moderate support for both cervical and lumbar medial branch block injections.

OUTCOMES AND EVIDENCE
  • Carette et al: lumbar facet injections; 58% relief after anesthetic injection but only mild difference between corticosteroid and placebo groups
  • Schulte et al: lumbar facet injections; 62% of patients reported significant relief at 1 month, 41% at 3 months, and 36% at 6 months
  • Destouet et al: intraarticular injections; 54% with relief initially and 38% at 3 months
  • Manchikanti et al: cervical medial branch block injections; 92% reported relief at 3 months, 56% at 12 months
  • Manchikanti et al: lumbar medial branch blocks; 73% to 93% relief at 3, 6, and 12 months
  • Esses and Moro: facet injections have no predictive value for benefit of surgery.
Procedure: Medial Branch Block Injection (Cervical Facet Joint)

Post-Procedure: Intraarticular Injection (Lumbar Facet Joint)

POST-PROCEDURE CARE
  • Observe the patient for at least 15 minutes but allow them to walk immediately.
  • Instruct the patient to not drive home and avoid strenuous activities for 24 hours.
COMPLICATIONS
  • Infection
  • Local injection site pain
  • Bleeding
  • Nerve block/nerve damage
  • Allergy to injection materials
ANALYSIS OF RESULTS

A 2007 meta-analysis showed limited support for the efficacy of intraarticular cervical facet injections, moderate support for lumbar intraarticular facet joint injections, and moderate support for both cervical and lumbar medial branch block injections.

OUTCOMES AND EVIDENCE
  • Carette et al: lumbar facet injections; 58% relief after anesthetic injection but only mild difference between corticosteroid and placebo groups
  • Schulte et al: lumbar facet injections; 62% of patients reported significant relief at 1 month, 41% at 3 months, and 36% at 6 months
  • Destouet et al: intraarticular injections; 54% with relief initially and 38% at 3 months
  • Manchikanti et al: cervical medial branch block injections; 92% reported relief at 3 months, 56% at 12 months
  • Manchikanti et al: lumbar medial branch blocks; 73% to 93% relief at 3, 6, and 12 months
  • Esses and Moro: facet injections have no predictive value for benefit of surgery.
Procedure: Intraarticular Injection (Lumbar Facet Joint)

Post-Procedure: Medial Branch Block Injection (Lumbar Facet Joint)

POST-PROCEDURE CARE
  • Observe the patient for at least 15 minutes but allow them to walk immediately.
  • Instruct the patient to not drive home and avoid strenuous activities for 24 hours.
COMPLICATIONS
  • Infection
  • Local injection site pain
  • Bleeding
  • Nerve block/nerve damage
  • Allergy to injection materials
ANALYSIS OF RESULTS

A 2007 meta-analysis showed limited support for the efficacy of intraarticular cervical facet injections, moderate support for lumbar intraarticular facet joint injections, and moderate support for both cervical and lumbar medial branch block injections.

OUTCOMES AND EVIDENCE
  • Carette et al: lumbar facet injections; 58% relief after anesthetic injection but only mild difference between corticosteroid and placebo groups
  • Schulte et al: lumbar facet injections; 62% of patients reported significant relief at 1 month, 41% at 3 months, and 36% at 6 months
  • Destouet et al: intraarticular injections; 54% with relief initially and 38% at 3 months
  • Manchikanti et al: cervical medial branch block injections; 92% reported relief at 3 months, 56% at 12 months
  • Manchikanti et al: lumbar medial branch blocks; 73% to 93% relief at 3, 6, and 12 months
  • Esses and Moro: facet injections have no predictive value for benefit of surgery.
Procedure: Medial Branch Block Injection (Lumbar Facet Joint)
About Procedures Consult | Help | Contact Us | Terms and Conditions | Privacy Policy
Copyright © 2017 Elsevier Inc. All rights reserved.