Image guided lumbar nerve root sleeve injection
What are the generally accepted indications for a lumbar nerve root sleeve injection? Radicular leg pain with good clinical localisation…Read more
Image guided facet joint corticosteroid injections can be used for diagnostic or therapeutic purposes.
Where it is not possible to withhold anticogulant agents, the added risk of significant bleeding, including intraspinal/epidural haemorrhage, should be discussed with the patient in order to allow for fully informed consent.
This is a very safe procedure and lower risk than both image guided epidural corticosteroid steroid injection and image guided nerve root corticosteroid injection.
Allergy to the local anaesthetic may produce itching and hives or, rarely, a more severe allergic reaction, as with an allergy to any medication.
Reaction to the corticosteroid is common, and produces redness and flushing of the face and body, usually starting a few hours or the day after the procedure and lasting a few days, the so called ‘cortisone flare’.
Allergy to corticosteroid ranging from a mild rash to anaphylaxis is very rare, occurring in fewer than 1 in 250,000 patients.
A numb arm(s) or leg(s) may result if the anaesthetic mixed with the steroid leaks into the adjacent epidural space. This lasts an hour or so in most people and is also uncommon.
Bleeding into the joint and joint infection are the more serious complications. These complications are extremely rare, as the procedures are always carried out under sterile conditions. If any of the following symptoms are experienced within the first 2 weeks after the patient’s injection, they should seek urgent medical advice:
Bleeding into the joint is very uncommon, and usually requires no active treatment and can be managed with pain medication and follow up with the patient’s local doctor. Joint infection is also extremely rare, but is potentially very serious. It usually requires treatment with antibiotics. In very severe cases, an operation may be required to remove the infected tissue, as well as a stay in hospital for intravenous antibiotics.
Radiofrequency ablation of the medial branch, usually after failure of facet joint blocks to provide long-term relief.
Utility of bone scan in assessing for symptomatic facet joints – there is some inconclusive evidence that symptomatic facet joints may show increased tracer activity on bone scan; however, the reliability of this data is questionable, and the sensitivity and specificity have not been determined.
Page last modified on 31/7/2017.
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