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Sunday, January 31, 2016

Facet Joint Injection guideline

Facet joint injection procedure guide 

Facet Joint injection procedure
Bismillahirahmanirahim , today the sharing info I would like to share is one of the treatment are advice by Dr to manage a back pain called Facet Joint injection, what can we understand about this procedure , I have discussed with my Spine surgeon to make me understand about this procedure and it keep me to prepare how to give a plan of treatment for the patient after post of injection under physiotherapy management .This information aims to give you a better understanding of these procedures. All procedures are a means to an end that is to improve function. Your average pain score should decrease by 4 on a 0 to 10 scale.1The duration of pain relief will depend on whether it is diagnostic or therapeutic (hours to weeks and months). There are differences in the way that these procedures are performed depending on the individual patient, the institution and the doctor. Therefore, not all of this information may apply to you. Please discuss your individual circumstances and concerns with your doctor or specialist.

Why am I having this procedure and what is facet joint injection ?
Facet joints in other terms also called zygapophyseal joints there are small joints of the spine that provide stability and help guide motion. They are found in the neck (cervical), upper back (thoracic) and lower back(lumbar). They can become painful as a result of arthritis, injury or mechanical stress. However, this is not necessarily the sole cause of long term back pain.
For your understanding there will be a 2 nerves called “medial branches” that is supply each facet joint. These  function and job duty of this nerves are to carry pain signals to the spinal cord and these signals will eventually reach the brain.

Picture of facet joint

What are the Dr will do when their apply this procedure to you ?
When this procedure is  carried out by the DR the facet joints and/or medial branch nerves can be injected with a local anaesthetic and/or steroid.
There are two reasons for doing this base on medical condition are
• Diagnosis: If the local anaesthetic in the injection relieves your pain then it suggests that the
facet joints are a source of your pain. Repeating the procedure a second time improves
accuracy of the diagnosis. This can guide future treatment such as "radio frequency
lesioning" of medial branch nerves. There is strong scientific evidence to support this.
• Therapy: The steroid in the injection can reduce inflammation, reduce medial branch nerve
sensitivity and provide long lasting pain relief. The duration of pain relief may vary from weeks
to months. There is limited to moderate scientific evidence to support this.
How the patient need to prepare of this procedure ?
The most important thing is communication between you and healthcare staff and Please advise staff if you are:
• Taking blood thinners (especially warfarin and clopidogrel)
• Have a history of Diabetic
• have in Pregnant (or any chance of you being pregnant).
• show and history of Allergic to iodine, betadine, shellfish, local anaesthetics, or steroids.
• Feeling Unwell (especially if you have an infection).

In our routine the medical Staff may advise you to:
• Fasting before the procedure
• Take your usual medications (apart from those mentioned above)
• Arrange for someone to accompany you home after DC from hospital.

What is the procedure is doing?
After arriving and completing the necessary paperwork and assessment
• You will be asked to change into a hospital gown
• A small cannula may be inserted into one of your veins.
• You may be given a mild sedative, but you will usually be awake throughout the procedure.
• Your heart rate and blood pressure are usually monitored throughout the procedure.
• You will lie face down on an x-ray table, the skin over the area to be injected is cleaned with
an antiseptic solution, and sterile drapes applied
• A local anaesthetic is injected into your skin
• An x-ray machine is used to guide a small needle into the facet joint and/or onto the medial
branch nerve. An x-ray dye (contrast) may be used to confirm the position of the needle.
• The local anaesthetic and/or steroid solution is injected.
• Multiple injections may be required.

What is post procedure will be happen?
You will be monitored in a recovery area until you are ready to go home (usually 20-60
• It is preferable to have someone take you home and stay with you for the next 24 hours.
• If you have received any sedation during your procedure, the effects of these medications may
last for up to 24 hours. You may not remember some of the information given during the
procedure. This is a normal side effect of the medication. For the next 24 hours you should
not drive a vehicle, drink alcohol, operate machinery, make important decisions, sign legal
documents or travel unaccompanied
• You will be given a pain relief chart to fill out. Please bring this to show the doctor at your next
• Please remove the dressing the day after the procedure, when you next wash.
• The pain may return when the local anaesthetic wears off. Some people experience an initial
increase in pain and stiffness that may continue for several days. If necessary, an ice pack
can be applied to the area, 20 minutes at a time, for 1-2 days following the procedure.
• If steroids are injected then it may take several days for the benefits to be noticed.
Additionally, you may feel flushed in the face and/or notice a change in your mood for a few
days. Diabetic patients may notice a rise in their blood sugar levels.
• After the procedure, care must be taken to avoid a rapid increase in your activities. Gradually
increase your daily activities as tolerated. Discuss this with your doctor.
• If you notice any swelling or bleeding from the site or have any other concerns, please contact
your General Practitioner, the Pain Management Unit, or the Emergency Department of your
local hospital.
·   Some of the pain management , the physiotherapist will be refer by the Dr and guide you about home management and to control the pain in physio procedure.

What are the risks of the procedure of this injection ?
All invasive procedures carry the risk of complications. In general the risk is low, but includes:
• Discomfort at the site of the injection
• Worsening of your pain (probably a temporary “pressure effect” from the injection).
• Infection
• Bleeding
• Allergic reaction to the medications.
• Fainting
• Nerve damage (due to direct trauma, the medication, infection or bleeding).
• Steroid-related side effects such as transient flushing, mood swings, high blood sugar levels
(especially in diabetic patients). The manufacturer did not specifically design most steroid
solutions for this procedure. Despite this, these medications have been widely used, over
many years, for this procedure without significant complications.
• Risks of sedation, if used (see separate document)

This info will be guide and give you some of the info about this procedure and it will be different approach by the Dr and the hospital management . Wallahuaklam..
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