Facet joint disease, often simply referred to as facet syndrome, is a condition that affects the facet joints as we age. When the cartilage in the facet joint begins to deteriorate the body tries to heal the instability by growing more bone. These bony growths are called bone spurs or osteophytes. When bending or flexing it is these arthritic joint conditions that cause pain. Although it is the facet joint that is affected in facet syndrome, nearby muscles may also go into spasm as they try to compensate for the motion restrictions. Facet Syndrome Symptoms Pain from lumbar and cervical facet joint disease comes and goes without warning. The pain will flare up anywhere from 1 to 2 times a month to a few times a year. Some symptoms of facet joint disease are: Tenderness at the point of injury Loss of flexibility Increased pain and discomfort while bending backwards In the lower back pain can radiate into the buttocks and down the back of the thigh. Facet joint disease in the neck will cause pain locally and to radiate into the shoulders.

1. DR SANDEEP C AGRAWAL!
AGRASEN HOSPITAL !
GONDIA MAHARASHTRA!
www.drsandeepagrawal.com!
www.agrasenortho.com!
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BACK PAIN
AND SPINAL INJECTIONS:
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Back pain is often a common symptom of many disease conditions and the back pain may
range from simple or dull pain to sudden and sharp pain. If the pain persists for few days, it is
acute pain whereas if continues for more than 3 months, it is considered as chronic pain. In
most cases, back pain may resolve without any treatment however if persists for more than 3
days, medical intervention is necessary.
Causes of Back Pain:
The human spine or back is composed of a complex arrangement of bones, discs, muscles,
ligaments and tendons. Each block of bone or vertebrae is separated by a cartlage like structure
called a disk. Problems with any of these structures may lead to low back pain. Occasionally the
causes of back pain is never found. The following are some of the most common causes of low
back pain:
strain – muscles or ligaments
1. Structural problems
2. herniated or bulging discs
3. sciatica
4. arthritis
5. abnormal curvature
6. osteoporosis
7. cauda equina syndrome
8. cancer of the spine
9. infection of the spine
10. shingles
11. bed mattress

2. 12. sleeping disorder and poor posture
Injections of Back Pain
Injections are a nonsurgical treatment option for low back pain. They are typically
considered as an option to treat low back pain after a course of medications and/or physical
therapy is completed, but before surgery is considered. Injections may be effective for
providing pain relief and as a diagnostic tool.
How Injections Relieve Back Pain
For pain relief, injections can be more effective than pills because they deliver
medication directly to the location that is generating the pain. A steroid medication is
injected to deliver a powerful anti-inflammatory solution straight to the area that is the
source of discomfort. Depending on the type of injection, some forms of low back pain
relief may be long term and some may be only temporary.
Injections to Diagnose the Cause of Back Pain
Diagnostically, injections can be used to help determine what is generating pain. If
lidocaine or similar numbing medication is used and the patient feels temporary relief
after an area is injected, it can then be understood that that specific region is the
source of the pain. When considered in combination with a patient’s history, physical
exam, and imaging studies, injections used for diagnostic purposes can be very
helpful in determining further treatment for the patient.
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SPINE INJECTIONS
Spine injection is a nonsurgical treatment modality recommended for treatment of chronic back
pain. Injection of certain medicinal agents relieves the pain by blocking the nerve signals
between specific areas of the body and the brain. The treatment approach involves injections of
local anaesthetics, steroids, or narcotics into the affected soft tissues, joints, or nerve roots. It
may also involve complex nerve blocks and spinal cord stimulation.
Spinal injections are used in two ways. First, they can be performed to diagnose the source of
back, leg, neck, or arm pain (diagnostic). Second, spinal injections are used as a treatment to
relieve pain (therapeutic).
Most spinal injections are performed as one part of a more comprehensive treatment program.
Simultaneous treatment nearly always includes an exercise program to improve or maintain
spinal mobility (stretching exercises) and stability (strengthening exercises).
Procedure:
Spinal injections are performed under x-ray guidance, called fluoroscopy. This confirms correct
placement of the medication and improves safety.

3. To do this, a liquid contrast (dye) is injected before the medication. If this contrast does not flow
in the correct location, the needle is repositioned and additional dye is injected until the correct
flow is obtained. The medication is not injected until the correct contrast flow pattern is
achieved.
Types of spinal Injections:
Epidural Injections:
Epidural injections are used to treat pain that starts in the spine and radiates to an arm or leg.
Arm or leg pain often occurs when a nerve is inflamed or compressed ("pinched nerve").
Epidural injections involve injecting an anesthetic and an anti-inflammatory medication, such as
a steroid (cortisone), near the affected nerve. This reduces the inflammation and lessens or
resolves the pain. This type of epidural injection is a therapeutic one.
For diagnostic purposes, an epidural spinal injection can be done at a very specific, isolated
nerve to determine if that particular nerve is the source of pain. Sometimes only an anesthetic is
injected. The immediate response to the injection is closely monitored. If the pain is completely
or nearly completely relieved, then that specific nerve is the primary cause of the pain
symptoms. If there is little pain relief, then another source of pain exists.
Facet Joint Injections:
Facet joint injections can also be done for both diagnostic and therapeutic reasons.
These types of injections are often used when pain is caused by degenerative/arthriticconditions
or injury. They are used to treat neck, middle back, or low back pain. The pain does not have to
be exclusively limited to the midline spine, as these problems can cause pain to radiate into the
shoulders, buttocks, or upper legs.
For diagnostic purposes, facet joints can be injected in two ways: injecting anesthetic directly
into the joint or anesthetizing the nerves carrying the pain signals away from the joint (medial
branches of the nerve). If the majority of pain is relieved with anesthetic into the joint, then a
therapeutic injection of a steroid may provide lasting neck or low back pain relief.
If anesthetic injections indicate that the nerve is the source of pain, the next step is to block the
pain signals more permanently. This is done with radiofrequency ablation, or damaging the
nerves that supply the joint with a "burning" technique.
Sacroiliac Joint Injections:
Sacroiliac joint (SI joint) injections are similar to facet joint injections in many ways. The SI joints
are located between the sacrum and ilium (pelvic) bones.
Problems in the SI joints have been shown to cause pain in the low back, buttock, and leg.
Typically, one joint is painful and causes pain on one side of the lower body. It is less common
for both SI joints to be painful at the same time.
This joint can also be injected for both diagnostic and therapeutic purposes. Anesthetizing the SI
joint by injection under X-ray guidance is considered the gold standard for diagnosing SI joint
pain. A diagnostic injection of the sacroiliac joint with anesthetic should markedly diminish the
amount of pain in a specific location of the low back, buttock, or upper leg.
A therapeutic injection will typically include a steroid medication, with the goal of providing
longer pain relief.
Provocation Diskography:
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Provocation diskography is a type of spine injection done only for diagnosis of pain. It does not
have any pain relieving effect. In fact, it is designed to try to reproduce a person's exact or

4. typical pain. This is to find the source of longstanding back pain that does not improve with
comprehensive, conservative treatment. It can severely aggravate the existing back pain.
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Diskography is performed much less commonly than the other types of spinal injections
reviewed above. It is often used only if surgical treatment of low back pain is being considered.
The information gained from diskography can assist in planning
the surgery.
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Diskography involves stimulating and "pressurizing" an intervertebral disk by injecting a liquid
into the jelly-like center (nucleus pulposus) of the disk. More than one disk is injected in order to
distinguish a problem disk from one without symptoms. Criteria are used to identify a painful
disk by provocation discography, including the type and location of pain and the appearance of
the disk on an X-ray after the procedure.
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5. Complications:
Spinal injection procedures are generally safe procedures. If complications occur, they are
usually mild and self-limited. The risks of spinal injections include, but are not limited to the
following:
• Bleeding
• Infection
• Nerve injury
• Arachnoiditis
• Paralysis
• Avascular necrosis
• Spinal headache
• Muscle weakness
• Increased pain
Common side effects from steroids include:
• Facial flushing
• Increased appetite
• Menstrual irregularities
• Nausea
• Diarrhea
• Increased blood sugar
Some people are not good candidates for spinal injections. These include people with:
• Skin infection at the site of needle puncture
• Bleeding disorder or anticoagulation
• Uncontrolled high blood pressure or diabetes
• Allergy to contrast, anesthetics, or steroids.

6. Dr.Sandeep C Agrawal
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Consultant Orthopaedic Surgeon
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Joint replacement & Spinal surgeon
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Complex Trauma Fracture & Revision Surgery Expert
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Agrasen Hospital Gondia
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Vidarbha Maharashtra India
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www.drsandeepagrawal.com
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www.agrasenortho.com
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