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Is it safe to have Facet shot for lower back pain?

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Posted on Thu, 28 May 2015
Question: I am on Plavix and have lower back pains Doc. want to give me a Facet Shot rather than an Epidural
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Answered by Dr. Matt Wachsman (19 minutes later)
Brief Answer:
ok......

Detailed Answer:
The facet shot is OUTside of the spinal canal. There is somewhat increased risk of bleeding with plavix (and probably at least as much risk with aspirin). The bleeding OUTSIDE of the spine. Might cause a (small) bruise. Maybe some (slight) irritation. Likely this goes away in a week or less. And even that isn't likely to happen at all. Bleeding inside the spinal canal isn't as easy to control. Could be an issue. That's why no epidural.

Bigger question is whether any of the shots have worked with you in the past. If they have, then it is very likely they will next time too. Many people never have them work.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Matt Wachsman (17 hours later)
A friend of mine who had 3 stints placed in 2012. In 2013 while still on Plavix he had a Facet injection to 3 joints ---36 hours later he was being operated on for a Epidural Hematoma on the spine.
750 cc of blood was removed and they though he would be paralyzed but survived. Today he has issues. I just don't want that happening to me. He is not sure why it happened but had 6 different leaks.
What caused this and what are the percentages it could happen again.
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Answered by Dr. Matt Wachsman (22 minutes later)
Brief Answer:
yeah, I think so too.

Detailed Answer:
Ok... the best available medical literature .. is written by surgeons.
Thing that prevents clotting... lots of blood... gosh, I think they might be related!
The medical literature doesn't show a lot of risk
http://www.ncbi.nlm.nih.gov/pubmed/0000
I'm rather dubious about that as you imply that so are you.
So... under 1 in 100 chance with epidural in the literature. Long after the stents, the plavix is irrelevant to them BUT it or aspirin lowers heart attack rate by up to 50%! And aspirin might even be worse for bleeding risk. So, there is some actual risk of stopping the plavix (or aspirin). I would not expect a facet injection to give spinal... anything. Maybe bleeding that large near the spine is a risk, but frankly losing a liter of blood is a risk of other things.
First question is whether you got that much benefit from injections in the past. Frankly I don't know anyone who would risk getting a parking ticket for the injections because I only see the people they don't help at all.
So, if they weren't helpful in the past it is a very easy decision. No.
If they were really helpful in the past I have to say injection outside of the spine should be a low risk of spine injury and TWO-THiRDS to THREE QUARTERS of facet injections have bleeding occur
http://www.ncbi.nlm.nih.gov/pubmed/0000
While bleeding we care about is only 1% that's gotta be much higher if there are risks of bleeding.
So... there's a risk of bleeding getting complicated in someone with a facet injection on a medicine that increases bleeding. Benefit would have to be very very good.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Matt Wachsman

Addiction Medicine Specialist

Practicing since :1985

Answered : 4201 Questions

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Is it safe to have Facet shot for lower back pain?

Brief Answer: ok...... Detailed Answer: The facet shot is OUTside of the spinal canal. There is somewhat increased risk of bleeding with plavix (and probably at least as much risk with aspirin). The bleeding OUTSIDE of the spine. Might cause a (small) bruise. Maybe some (slight) irritation. Likely this goes away in a week or less. And even that isn't likely to happen at all. Bleeding inside the spinal canal isn't as easy to control. Could be an issue. That's why no epidural. Bigger question is whether any of the shots have worked with you in the past. If they have, then it is very likely they will next time too. Many people never have them work.