Lumbar: Low back
Facet: Joint
Steroid: Strong anti-inflammatory
Frequency: Usually performed on both sides of the low back or on the same side at 2 different levels depending on where your pain is located. This is typically repeated in 2 weeks if you have gained some relief from the initial procedure. If you had no relief and/or your relief is not sustained, you may be a candidate for a procedure to numb the nerves in your low back that tell the joint it has pain (see lumbar medial branch blocks). If this decreases the pain in your low back by at least 50% for a certain period of time, then you would be a candidate for a procedure to maintain this pain relief for an average of 6 months (see lumbar facet denervation).
Anesthetic: Local
Indications:
The second leading cause of mechanical low back pain is arthritis in your joints of your lower back (see lumbar facet syndrome). Pain typically comes from the joints that become irritated and subsequently swollen (inflamed). By placing a steroid, which is a strong Anti-inflammatory, into the inflamed joint, this decreases the swelling which thereby decreases your pain.
This injection is used to not only treat arthritis in your spine that is causing chronic low back pain but also can be used to treat acute low back pain that occurs after a lifting and/or twisting injury. Low back pain after a car accident may also benefit from this procedure. The low back pain can radiate to your buttocks/hips and sometimes to the knees. If the pain radiates below the knees you have a disc problem in your low back causing your pain (see lumbar radiculopathy).
Contraindications/Reasons why you may not have your injection today:
- Bleeding disorders/low platelet counts
- Medications that thin your blood (please review this section)
- Current infection
- No driver
- Your symptoms have changed and/or improved
- Patient refusal
- Procedure not approved by your insurance
- Poorly controlled high blood pressure that may be giving you symptoms
- Poorly controlled diabetes
- Certain types of glaucoma
- Poorly controlled bipolar disorder
- Allergies to the any of the medications that is being used
Potential side effects/risks of the procedure:
- Increased pain
- Numbness in lower extremities that is short lived
- Infection
- Bleeding
- Allergic reaction to medications used to clean your skin and/or medications injected
- Cramping in lower extremities
- Mood changes
- Flushed face/extremities
- Headaches
- Worsening of high blood pressure
- Increasing of blood sugars if you have diabetes
- Water retention
- Chronic steroids can cause weight gain
- Seizures
- Stroke
- Nerve and/or spinal cord injury
Procedure:
During the procedure, you will be lying on your stomach. An x-ray machine is used to locate the specific level of the spine which is believed to be causing your pain based upon where you hurt in your low back. After your skin is cleaned with an antiseptic solution, normally betadine unless you are allergic, a series of x-rays will be taken to guide the needle placement. The skin is localized with a local anesthetic which is typically the most painful part of the procedure as this medicine has a tendency to burn when it is injected. After this point, you should only feel pressure. If anything is too painful for you, please tell your physician, as more numbing medicine can be given at any time. When the needle enters into the joint, a mixture of local anesthetic and steroid is slowly injected. You may experience increased pressure/pain in your low back/buttocks region which is normal. At times, you may even feel pressure down the leg(s). That is also to be expected. However, if at any time the pain is too intense, please tell your physician to slow down your injection. After the medication is injected, the needle is removed. As more than one joint is involved in causing you pain, the procedure will most likely be repeated at a different level.
Typical length of the procedure:
5 minutes. Expect to be at the clinic no more than 15 minutes after you have been checked in by the medical assistant into the preoperative area. If this is your first time at our clinic, you will likely be at the clinic for at least one hour. Please plan accordingly.
How long do you expect pain relief:
It is difficult to determine how long and how much pain relief you may experience. It varies depending on multiple factors. Some patients do not gain any relief from the procedure and some may have permanent pain relief. If you experience relief right after this procedure, this can be diagnostic that your pain is coming from the specific joint(s) that were injected today.
