Lumbar Facet Injection

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For Chronic Low Back Pain

A lumbar facet injection is an outpatient procedure used to diagnose and treat pain in the low back, buttock, hip, or groin.

Facet joints are the joints that connect the vertebrae, or the bones of the spine. These joints are important because they help guide your spine whenever you move. The lumbar region, or the low back area of the spine, contains five vertebrae with corresponding facet joints.

Facet joints are found on both sides of the spine, each being about the size of a thumbnail. Lumbar facet joints are named for the vertebrae they connect, as well as the side of the spine where they sit. For example, the right L4-5 facet joint connects the fourth and fifth lumbar vertebrae on the right side of the spine.

You may feel pain if a lumbar facet joint becomes injured. The pain may be minor, like muscle tension, or more severe. Injuries can occur to the cartilage inside of the joint or the ligaments surrounding it. 

Facet pain can occur in different areas depending on which joint is affected. Lumbar facet joint pain can take place from your low back to your buttocks, groin, or hips. 

X-rays and MRIs may not always be able to show if a facet joint is the cause of your pain. However, there are several other ways to tell. You may have lumbar facet pain if you experience pain lasting more than two months in one or more areas on the diagram. Your doctor can evaluate your symptoms for a more accurate diagnosis.

In a lumbar facet injection, a local anesthetic and corticosteroid are injected into one or more of your lumbar facet joints. The anesthetic will effectively numb you while the corticosteroid reduces inflammation. 

The injection can be used to diagnose or treat lumbar facet pain. If these medications temporarily reduce your pain and help you move better, it tells the doctor which facet joint may be causing your pain. 

Before the procedure begins, a local anesthetic will be used to numb your skin. The doctor will then insert a small needle into the facet joint. Fluoroscopy, a type of x-ray, and injected dye will be used to ensure the safe and proper positioning of the needle. Once the doctor is sure the needle is correctly placed, the medicine will be injected.

You will be monitored for up to 30 minutes after the injection. When it's time to leave, the staff will give you discharge instructions and a pain diary. It is important to fill this out because it helps your doctor know how the injection is working. Tracking your progress will help them determine the best treatment method moving forward. 

It helps to move your back in ways that hurt before the injection to see if the pain is still there, but be careful not to overdo it. Take it easy for the rest of the day. You may feel immediate pain relief and numbness in your back for up to six hours after the injection. This tells us that the medication reached the right spot.

Your pain may return after a short period, or it may get a little worse for a day or two following the injection. This is normal, and can be caused by needle irritation or by the corticosteroid. Corticosteroids usually take two or three days to start working but can take as long as a week. You may be able to return to work the next day, but it's important to check with your doctor.

Your level and length of pain relief may change depending on the amount of inflammation and how many areas are involved, along with other individual factors. Coexisting factors may be responsible for your pain, so this something else we will monitor and address. 

An injection can bring several weeks or months of pain relief before more treatment is needed. For others, particularly if there is no underlying bone or joint problem, one injection brings long-term pain relief. If your pain is caused by injuries to more than one area, only some symptoms may be helped by one injection.

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