Cervical facet joint surgery is a minimally invasive treatment used to diagnose the location and cause of your pain and offer spine pain relief. You could be an ideal candidate if you have injured your neck or suffer from spinal arthritis or stress on your spine. The procedure entails injecting steroids and anesthetics into your cervical facet joints under diagnostic imaging guidance. Dr. George Rappard Practice is dedicated to helping you to stay active and live a fulfilled life in Los Angeles. Using advanced contemporary treatments, we can conduct a thorough evaluation and help you find relief from your pain.
Defining Cervical Facet Joint Surgery
A cervical facet injection is a medical procedure that injects numbing medicine (local anesthetic) and steroid medications to relieve and prevent pain from your neck facet joints. Your facet joints can be painful due to facet syndrome, which is caused by either:
- workplace stress due to repetitive movements, or
- trauma from a whiplash injury.
The facet joint is a tiny bone joint in the cervical spine that permits you to turn, bend, twist, and move the neck and offers stability. They come in pairs of joints on the spine's sides, from the neck to the lower back. They act as connectors to your spinal bones, offering greater flexibility and additional support. They are made of cartilage and a nearby capsule with synovial fluid that lubricates your joints, allowing them to function.
When the cartilage between your facet joints becomes brittle and thin, flakes break off into the synovial joint fluid that facilitates movement. The pain erupts when degeneration of your joint cartilage results in friction between your bones that have lost cartilage.
Some symptoms of cervical facet pain include the following:
- Pain when you bend or twist.
- Tenderness in your upper torso or neck.
- Splitting headaches.
- Radiating pain that extends into your upper hand, middle back area, or shoulders.
- Limited ability to rotate or extend your shoulders and neck.
The cervical facet joint injection relieves pain and allows you to endure physical therapy (PT) and rehabilitate the neck pain. Cervical facet injection aims to:
- Offer pain relief — Numbing and steroid medications are injected into your cervical facet joints to lower inflammation, providing pain relief.
- Diagnose the cause and location of your pain.
Ideal Candidate for Cervical Facet Joint Surgery
You qualify for the medical procedure if you suffer from shoulder and neck pain originating from cervical facet joints and conventional treatment options like physical therapy have failed.
However, you should avoid cervical facet surgery if you:
- Are allergic to steroids or local anesthetics.
- Have systemic bacterial infections.
- Are pregnant.
- Have a bleeding disorder.
- Suffer from a spine infection or a tumor of your spine.
- Have diabetes or a congestive heart failure.
- When the possibility of holding specific medications like blood thinners, antiplatelets, and aspirin outweighs the benefits of the epidural medical procedure.
How to Prepare for the Injection
On your medical procedure day, you are advised to:
- Avoid engaging in strenuous activities.
- Limit painkillers so that the diagnostic information your doctor acquires is correct.
- Avoid drinking alcohol, especially if you are sedated for 24 hours after the injection.
- Specific medications like Aspirin, NSAIDs, Aggrenox, heparin, and Prasada should be held before the elective spinal procedure. Your physician should list the medications to hold and for how long. Also, consult your doctor before stopping any medication.
- Remember to carry your updated list of allergies and medications. Please highlight if you are allergic to Iodine, Latex, or contrast.
- On your medical procedure day, wash your skin with soap. Do not wear mediated creams or lotions at the injection site. Wear loose-fitting clothing and an undergarment.
- Arrive early at the doctor’s office and bring a person to take you home.
What to Expect During Your Procedure
After arriving at your doctor’s office, a medical assistant will take you to a pre-op space where they will place an ID wristband with your name on the wrist. They will also review your medication and check your coagulation and blood sugar status. Then they will escort you to the operating room, where you will lie with your face facing down.
The doctor will clean your injection site before administering local anesthesia, so you will not feel pain during your medical procedure.
Then your physician will insert a thin needle through your muscles to the nerves in your facet joint. Fluoroscopic X-rays that give real-time images of the needle’s position in your spine on a monitor will guide the surgeon.
Next, they inject contrast material through the needle to ensure the medication flows to the problematic nerve when injected. Once the physician is satisfied with the needle’s position, they inject corticosteroid and anesthetic drugs via the needle inserted in your spine.
While you could feel pressure during surgery, the medical procedure is not painful. After removing your needle, your doctor will cover your injection site with a sterile bandage before transferring you to the recovery room for a 45-minute observation.
A medical assistant will review your vitals, advise you on discharge guidelines, and answer all your questions.
Depending on your pain’s location, the doctor can inject multiple facet joints. Therefore, the procedure’s duration will depend on the number of injections needed to relieve pain.
Is Cervical Facet Injection Painful?
You could feel a pinch and a slight burning sensation during your local anesthesia injection as it becomes effective. The injection itself is not painful since your injection site will be numbed. You could also feel pressure around your injection site.
After the painkiller wears off, you could have soreness around your injection area for several days.
Discharge Guidelines and Instructions
You could experience increased pain lasting for days as the local anesthesia wears off before the cortisone becomes effective.
In the days following your medical procedure, recommendations include the following:
- If your injection site is still uncomfortable after the medical procedure, carefully apply a cold pack or ice to the area to relieve pain.
- While it is okay to shower after the injection, do not submerge yourself in water or bathe for twenty-four hours.
- Avoid engaging in strenuous activity or operating/driving machinery for twenty-four hours following the procedure.
- If sedated, avoid making essential life or financial decisions until the effect of the medication clears.
- You can remove your bandages a day after your injection. Ensure you consult your doctor if you have infection signs like a collection of pus at your injection site, discharge, warmth, or excessive redness.
- You can resume your diet.
- If you have diabetes, monitor your blood sugar thrice daily for three days following the injection.
- Once the pain is improved, it is recommended to begin regular activities and exercise in moderation. Even when your pain relief is substantial, gradually increase your workouts to avoid recurring pain.
Facet Joint Injections Pain Relief Outcome
If your treated facet joints were the root cause of your pain, you will experience immediate pain relief from the anesthetic. You could start noticing lasting pain relief from steroids a couple of days following the injection.
If patients have immediate relief with the numbing medications but do not have lasting improvement with the steroids, the doctors could perform more treatment (radiofrequency neurotomy) and diagnostic tests.
If your symptoms fail to improve with local anesthesia, more diagnostic tests will be required to diagnose your pain correctly.
While cervical facet surgery can be effective for several patients, its success rate varies depending on factors like:
- The patient.
- The healthcare provider’s skill.
- The underlying condition being treated.
What Happens If the Injection Fails to Work?
If your injection fails to provide pain relief, it could be because the pain is not caused by facet joints or the treatment did not reach the root cause.
Your trained physician can recommend the next course of action. They could suggest trying another injection or an alternative treatment option where the doctor uses heat to destroy your pain-causing nerves.
Potential Complications and Risks
Cervical facet joint surgery has potential complications and risks, like all invasive medical procedures. However, they are rare.
They include the following:
- Allergic reactions — Typically, the patients are allergic to steroids or X-ray contrast. Allergies to local anesthesia or severe allergies are rare.
- Bleeding — Bleeding is common among patients on blood thinners or with underlying bleeding conditions.
- Discomfort at the injection site or worsening of pain symptoms — The symptoms are short-lived and mild.
- Paralysis or spinal cord or nerve damage — Damage to your spinal nerves or spinal cord can happen from direct trauma from the needle, infection, injection into an artery leading to blockage, or bleeding causing compression.
On top of the risks stemming from the injection, some patients can experience the following side effects from steroid medications:
- Hot flashes (transient flushing with a warm feeling) for days.
- Increased appetite, weight gain, or fluid retention.
- Low immunity.
- High blood sugar.
- Insomnia, anxiety, irritability, and mood swings.
- Increased blood pressure.
- Decreased bone density and fractures.
Cervical Facet Joint Surgery Costs
The surgery cost depends on numerous factors, including the healthcare facility or provider, the patient’s insurance coverage, and the healthcare facility’s geographic location.
The injection is a minimally invasive medical procedure in outpatient settings. The cost could include many components, including the following:
- Imaging costs.
- Anesthesia fees.
- Facility fees.
- Professional fees.
While it is hard to give an exact price estimate, the cost of injections ranges between $500 and $2,000 per injection.
Consult your doctor or health insurance provider for the correct price estimate based on your coverage and specific situation. They will also tell you the out-of-pocket expenses you could incur.
Medicare and Insurance Coverage
Medicare can cover your injection if you meet the requirements below:
- More than three months of moderate to serious pain with a functional impairment that has failed to respond to conservative treatments.
- Pain unrelated to impinged nerves.
- You do not suffer from other non-facet health conditions that can explain your pain.
- A physician’s assessment that suggests your joints are the root cause of the pain.
Other health insurance providers can cover all or part of your surgery. Please consult your insurer to learn more.
Post-Cervical Facet Joint Surgery Exercises
Your exercise routine after the surgery could look like a daunting task. With proper preparation and planning, you get through it successfully. Below are tips to make your exercise experience easier:
- Ensure you have the appropriate supplies, including water, pain relief medications, and an exercise outfit.
- Start slowly and gradually increase the intensity and duration of your exercises as your body adapts to your new routine. Make sure you listen to your body.
- Pay attention to your breathing. It will help you relax and focus during your exercise.
- If you are tired, stop and rest for a couple of minutes before resuming.
After your cervical facet injection, you could feel like you cannot do anything. That is untrue. Your doctor should guide you on the exercises you can engage in and what to avoid. Some exercises to contemplate include the following:
- Walking — While you should not exercise vigorously after your injection, you should walk periodically. Ensure you stroll for more than five minutes after sitting for 30 minutes.
- Beginner moves — To start exercising as part of your rehabilitation, begin with simple exercises that do not strain your back. You can consider wall squats and ankle pumps.
- Intermediate to advanced exercises — Floor stretches are ideal for your intermediate and advanced exercise program.
You should avoid running for two weeks following the medical procedure and progress gradually from walking to jogging to running as tolerated. Running is a high-impact activity that places your body weight on every leg three times, causing stress on your spine.
Contact a Skilled Surgeon Near Me
Cervical facet joint surgery is designed to be a means to an end. Successful injections can relieve pain, allowing you to return to rehabilitation programs, which can eliminate the need for invasive treatment options. The injections are also therapeutic and diagnostic. Dr. George Rappard’s practice’s priority is helping you find immediate and long-term pain relief, and can help you determine if you are an ideal candidate for the medical procedure. Please call 424-777-7463 to schedule your consultation at our Los Angeles office and get started.