This 3D video demonstrates in detail about how Lumbar Facet Joint Injection is performed for chronic pain in lower back
Lumbar Facet Joint Injection is performed for chronic pain in lower back radiating into the buttocks and upper legs mostly posteriorly above the thigh. Facet joint injection is performed in the operating room using the x-ray and under sterilization and aseptic environment.
Facet Joint is identified by using x-ray. First of all patient is positioned on the operating bed. Patient is brought in the operating room and requested to lie prone on the operating bed. A pillow is placed under the belly to create a flexion of the spinal and vertebral column. Patient's skin over the facet joint is prepped with antiseptic solution as suggested by the surgical center and joint commission. X-ray is used to identify the facet joint which is supposed to be injected. Facet joint injection is performed for diagnostic purpose as well as therapeutic reason. Diagnostic injection is performed to evaluate the cause of the pain if it is facet joint arthritis or hypertrophy. Diagnostic injection is performed between 1 to 2 facet joints at a time. Facet joint pain may be unilateral or bilateral. Diagnostic injection could be multiple injection if the first or second injection failed to relieve the pain. Therapeutic injection is performed for the treatment for the chronic intractable pain which is not responding to the pain medications and physical therapy. Therapeutic injections are repeated after the initial treatment every 2 to 4 months. Patient may be onsidered for nerve ablation of the facet joint if cortisone injection pain relief doesn't last for morethan 3 months.
Once the patient is prepped for the injection treatment, the local anesthesia is used to anesthetize the skin and subcutaneous tissue. The facet joint is observed by using the x-ray. The AP as well as oblique view of the x-ray is used to identify the facet joint which is schedule to inject the medications. Once the facet joint is identified, the marking pen is used to mark the skin where the needle will be inserted toward the facet joint. The skin or the marked area is anesthetized with local anesthesia such as 1% Lidocaine. The amount of Lidocaine injected is 1 to 2 cc using 25 gauge needle.
The facet joint injection is performed by using 22 or 23 gauge spinal needle. The needle is passed under the guidance of the x-ray. The needle is placed over the facet joint and needle is inserted into the facet joint. Once the needle is placed into the facet joint, the dye is injected. The dye injection could be between 0.1 cc to 0.5 cc. The severe degenerative disease or arthritis may not have a space within the facet joint and needle placement within the facet joint may not be possible. In this case injection is performed at the top of the facet joint so the medications are spread over the facet joint. Once thefacet joint is identified with the dye, the medications are injected within the facet joint. Facet joint is a thin and narrow space so amount injected into the facet joint depends on the space. The amount injected in the facet joint could be from 0.2 cc to 0.5 cc. Medication injected is 0.5% Marcaine and corticosteroid. Corticosteroid injected is either Depo Medrol or Kenalog. After the injection, patient is observed in the recovery room for any complications as well as pain relief. Patient is discharged home after the procedure.