Facet joint injections are simple and safe procedures that are well-tolerated by most patients.
As with any injection procedure, there are potential risks associated with the procedure, but the side effects typically involve minor and transient discomfort, and serious complications are rare.
In This Article:
- Cervical, Thoracic, and Lumbar Facet Joint Injections
- Facet Joint Injection Procedure
- Facet Joint Injection Potential Risks and Complications
- Facet Joint Injections Procedure Video
Potential Side Effects of Facet Joint Injections
Common side effects of facet injections include pain and tenderness at the injection site.
Localized effects at the site of injection are common in facet joint injections, including,:
- Pain and tenderness
- Swelling
- Numbness
- Minor bleeding and bruising
- Worsening back or neck pain
In most cases, these effects resolve within approximately 48 hours.
Managing the side effects of facet joint injections
Ice therapy controls injection-site pain during the first few days after the procedure.
It is possible for patients to experience an increase in pain or discomfort for a few days following the procedure as the anesthetic wears off and the corticosteroid’s anti-inflammatory action begins to take effect.
Additionally, some patients experience an increase in pain at the injection site due in response to the formulation of corticosteroids used in the injection that causes irritation at the joint. This phenomenon is known as a “steroid flare” and usually resolves within a few days.
Recommendations for managing pain during this interval include:
- Careful application of ice or a cold pack to the general area of the injection
- Use of prescription pain medication or over-the-counter treatments
Pain medication is sometimes limited for a few hours immediately after the procedure to allow accurate diagnostic or therapeutic results assessment.
Potential Risks and Complications of Facet Joint Injections
Serious adverse events from facet joint injections are rare, but there are risks related to injection technique and the medications administered, including,:
- Infection
- Allergic reaction to drugs or contrast dye
- Nerve damage
- Spinal cord injury or paralysis
- Excessive bleeding and bruising
- Vasovagal reaction (eg, dizziness, nausea, and flushing)
These events are possible with injections in all spinal regions, but cervical procedures are associated with additional complications, including vertebral artery damage and phrenic nerve palsy.
Potential risks of corticosteroids used in facet joint injections
Serious adverse reactions to corticosteroids (eg, triamcinolone and dexamethasone) are possible due to the slow systemic absorption of the drugs from the intra-articular space, including:
- Increased blood pressure (hypertension)
- High blood sugar (hyperglycemia)
- Immunosuppression
- Decreased bone mineral density
- Osteonecrosis
- Cataracts (with long-term use)
- Reproductive hormone imbalance
- Psychiatric changes (eg, mood swings, irritability, and insomnia)
- Metabolic changes (eg, increased appetite, weight gain, and fluid retention)
The risk of these adverse effects is increased with higher doses of corticosteroids and multiple injections, and it is recommended to monitor patients with underlying risk factors (eg, diabetes, heart failure, and psychiatric conditions) closely.,
Long-term risks of facet joint injections
In some cases, nerve injury, prolonged use of corticosteroids, and unmanaged infections cause structural changes and lasting effects, but the incidence is rare.
It is advisable to discuss the risks, benefits, and alternative treatments with your doctor before having a facet joint injection.
