Facet Joint Injection, Thoracic Spine

KEY FACTS

Terminology

• Injection of long-acting anesthetic ± corticosteroid into thoracic facet joint

Preprocedure

• Preprocedure imaging

  • Correlate level with prior imaging

    • –

      Evaluate for 12 ribs &/or transitional vertebral anatomy

• Indications for procedure and future treatment plan

  • Is facet joint injection or medial branch block more appropriate?

Procedure

• Fluoroscopy

  • Align margins of facet joint to maximize visualization of joint space

  • Contrast is useful to evaluate intraarticular injection during fluoroscopy-guided facet injection

• CT

  • Gantry angulation may be necessary to “open” facet joints

  • Sagittal reformats helpful for determining correct level and angulation of needle

Post Procedure

• Improvement/relief of pain referable to facet joint(s) injected

  • < 100% pain relief decreases likelihood of successful outcome following facet neurolysis/radiofrequency ablation

Outcomes

• Most feared complications

  • Spinal cord/nerve root injury

  • Pneumothorax

  • Epidural hematoma

TERMINOLOGY