Cervical facet joint injections

Facet joints are small joints lying at the back of the spine. There are a pair at each level. Structurally, they are same as a hip or knee joint and similarly can become inflamed due to the wear and tear on the cartilage surface. Pain from a facet joint will be felt in the back of the neck and typically can radiate up to the back of the head, across to the upper arms and down to the shoulder blades.

The pain will tend to come and go and may flare up for no particular reason. The severity can be very variable. Most people complain that they are stiff first thing in the morning,

If symptoms are persisting and interfering with day-to-day life, an injection of anti-inflammatory medicine direct to the source of irritation, can provide excellent pain relief. The injections will typically be followed by a course of physiotherapy as the aim is to kick start your ability to rehabilitate and strengthen your back and neck muscles..

A variable number of joints will be injected. Typically between one and six, depending on the circumstances.

The Procedure

The procedure is performed under local anaesthesia under CT guidance, by a specialist radiologist. The CT scanner is not as enclosed as an MRI scanner and should not cause claustrophobia.

The procedure is performed as an out-patient. Expect to be at the hospital for at least one hour. Please have someone to accompany you and you should not plan to drive home. You can eat and drink normally beforehand.

The radiologist, a doctor, will meet you beforehand to explain the procedure and to ask you to sign a consent form.

You will be taken into the CT room and positioned on your back. An initial local anaesthetic injection will be made (to numb the injection site and surrounding area) and a planning scan will be performed. One or more needles will then be inserted into the side of the neck and advanced so that they are placed just next to the appropriate joint(s). The position of the needle will be checked in the CT scan before the injection of a combination of local anaesthetic (Bupivicaine) and steroid (Triamcinolone) is made.

The procedure may be painful, if the joints are irritable.

Once the procedure is done, usually, after a cup of tea, you can go straight home and take it easy for the rest of the day.

There may be immediate benefit due to the quick acting local anaesthetic component. Sometimes the immediate benefit wears off before the steroid benefit kicks-in a few days later.

You should continue to take your usual pain relief medication until you begin to feel benefit. It is important not to stop taking certain pain relief medication suddenly, such as, morphine or neuropathic medication (gabapentin, pregabalin or amitriptyline).

The duration of benefit is variable and ranges between a few days benefit to no return of pain. For a considerable number of patients, the injections provide excellent pain relief during which time the underlying problem can resolve itself.

If the symptoms have not improved by 10 day, the injection is probably not going to help.

Typically, Mr Allibone will see you in clinic following the injection at between one to three weeks depending on the circumstances.

The Risks

Fortunately, there are very few risks associated with nerve root injections. Very uncommon risks include:

  • Bleeding. You must inform your consultant if you are taking tablets used to ‘thin the blood’, such as warfarin, rivaroxaban or clopidogrel. You will need to stop taking these before your injection. Mini aspirin is fine.
  • Infection. This is very rare
  • Facial flushing. Typically, this lasts a few days only but can look quite dramatic.
  • Interference with the menstrual cycle or post-menopausal bleeding. This can be a temporary side effect of the steroid.
  • A rise in blood sugar levels for a few days for people who have diabetes.
  • A needle injury to the dura (the membrane around the nerves). This can result in a small leakage of the cerebrospinal fluid (CSF), which can lead to a headache (when standing and walking) for a few days afterwards. If this does occur, you may be advised to lie down for a few days until the leakage stops. This is very unlikely with a neck injection.
  • Allergic reaction to the injection. Rare
  • Stroke. Very rare cases of stroke have been described. These cases are due to a disturbance of the blood flow to the brain, probably related to positioning of the neck and rarely due to misplacement of the needle.

Injections