Introduction
In partnership with Camden MSK, our department has agreed to provide ultrasound-guided cervical (neck) and lumbar (lower back) facet joint injections to patients referred by the Camden community MSK services.
Why an injection?
Facet joints are the small joints between the bones (vertebrae) in your back or neck. Arthritis or wear in these joints may cause pain. Injection to this area may help to reduce symptoms of pain or help to confirm the source of your back or neck pain.
What is in the injection?
Your doctor will inject a combination of local anaesthetic and corticosteroid. Local anaesthetic works in the short term. Corticosteroid aims to reduce inflammation, and it can take longer to take effect, but it should provide longer term pain relief. The improvement of symptoms after this injection varies from person to person.
What are corticosteroids?
Corticosteroids are anti-inflammatory medicines used to treat different conditions (e.g., corticosteroids inhalers are used to treat asthma). When given as an injection they can be used to reduce pain and swelling in a facet joint. Corticosteroids are not the same as anabolic steroids, which are used illegally to increase muscle bulk.
What areas are injected?
The injection is into one or more facet joint of the lower back or neck. The which facet joints are injected is determined by a combination of pain location, physical examination and imaging (e.g., X-rays or MRI). The facet joints are accessed through the lower back or neck under the guidance of ultrasound.
Is the injection painful?
The injection can be uncomfortable, but this tends to resolve quickly. Sometimes it can be sore for a few days after, and you will be advised by your doctor how to best manage this.
What are the risks?
Overall, nerve root injections are considered a safe procedure. Adverse reactions are rare, but may include:
More common (<10%):
- Mild bruising/bleeding in & around the injection site.
- A change in sensation or weakness in your affected leg/arm.
- (this should resolve after a few hours if it occurs)
- Vasovagal reaction.
- Transient dizziness/fainting due to blood pressure drop (this typically resolves. within 15-30 minutes after the injection).
- No effective pain relief in the affected area.
- Steroid flare – increase in pain for a few days after the injection.
Rare (<1%):
- Severe allergic reaction that requires emergency treatment (anaphylaxis).
- Headache.
- Nerve or spinal cord injury.
- Infection.
- Facial flushing.
- Skin discolouration or skin fat reduction (atrophy) at site of injection.
- If you are diabetic, your blood sugar may be slightly higher for one to two weeks.
- Irregular menstrual cycle (usually for one to two months).
Extremely Rare (<0.1%):
- Pain permanently worse.
- Paralysis.
- Blindness.
- Hiccups.
Your doctor will take every necessary precaution to reduce the risk of complications and will discuss these with you.
How is the injection done?
Firstly, the skin is cleaned with antiseptic liquid. Under ultrasound-guidance a small needle is then gently put into the affected facet joint and the solution is injected through the needle. A separate injection for each facet joint is generally required, which can be done at the same appointment.
Why ultrasound-guided?
The use of ultrasound allows your doctor to see the area that needs to be injected and accurately place the needle. This improves both accuracy and safety of the injection.
Medications
If you are taking Warfarin, please ensure your INR is less than 3.0. Other blood thinning medications (e.g., rivaroxaban, dabigatran, apixaban, aspirin & clopidogrel) can usually be taken as normal before the procedure. Please seek advice from your consultant or medical team if unsure.
Aftercare
After the injection it is advised you rest in the waiting room for 20-30 minutes before walking out of the clinic. Your doctor will discuss how look after yourself after the injection and how to spot signs of complications.
How to contact us
Patient Services
The Royal London Hospital for Integrated Medicine (RLHIM)
60 Great Ormond Street, London WC1N 3HR
Tel: 020 3448 2000
Switchboard: 020 3456 7890
Email: uclh.
Website: www.uclh.nhs.uk/RLHIM