Facet Joint Injection, Lumbar Spine

KEY FACTS

Terminology

• Injection of corticosteroid and anesthetic into lumbar facet joint

Preprocedure

• Facet joint osteoarthritis

• Synovial cyst causing neurologic symptoms

Procedure

• Prone

• Angle C-arm or PA fluoroscopy tube slightly toward side of joint to be injected

  • Generally, lower 1/3 of joint is most amenable to needle entry/injection in arthritic joint

• Ensure proper level

• Slowly inject only enough contrast to confirm that needle tip is in joint space

• Note pain scale and pain characteristics

  • Before, during, and after injection

• Synovial cyst therapeutic rupture

  • May require significant injection pressure

  • See sudden spread of contrast into epidural space

Outcomes

• Failure to alleviate pain

  • Wrong level injected

  • Injection extraarticular

  • Facet joint not source of pain

  • May require multilevel injections

• Most feared complications

  • Thecal sac puncture, cord injury, meningitis

• Other complications

  • Nerve root injury, bleeding, infection

TERMINOLOGY