Facet joint injections are used to diagnosis and treat pain emanating from the facet
joints. Facet joints are small joints located in pairs at the cervical (neck), thoracic
(midback), and lumbar (low back) spine. These joints provide mobility as well as
stability for the spine. Patients with facet joint pain (often referred to as “facet
joint syndrome”) typically complain of local pain at the spine, but can also have
referred pain into the arms or legs.
What is a facet joint injection?
A facet joint injection is an injection of medication either directly into the facet
joint or along the nerves that supply the facet joint.
There are two approaches for injecting facet joints:
1) Intra-articular approach: local anesthetic and corticosteroid injected directly
into the joint.
2) Medial branch block approach: local anesthetic (and sometimes corticosteroid)
injected along the nerves that supply the joint. It remains controversial, whether
or not using corticosteroid with this approach is beneficial.
At Loudoun Spine and Rehabilitation, facet joint injections are only performed under
fluoroscopy (x-ray guidance) to ensure patient safety, patient comfort, and to make
sure the medication will be delivered to the targeted areas precisely.
How is a facet joint injection diagnostic?
It is widely accepted that the facet joints can be a pain source when one experiences
neck or low back pain. Unfortunately there is not a history or physical examination
finding or an imaging study finding which reliably diagnoses pain from the facet
joints. The local anesthetic component of the facet joint injection is the “gold
standard” for determining if a patient has pain from the joint. If the local anesthetic
relieves a significant amount of the patient’s neck or low back pain, this suggests
their pain is emanating from the facet joints
Usually the patient will asked to complete a Pain Diary for a few hours after the
procedure to track the amount of pain relief obtained from the injection. The patient
does not need to stay at our office to complete the Pain Diary. The Pain Diary can
be completed at home or work.
How can a facet joint injection be therapeutic?
If a patient has pain from the facet joints, the corticosteroid component of the
facet joint injection will reduce the inflammation at the joint and thus reduce pain
from the joint. For medial branch blocks with local anesthetic alone, pain relief
beyond the duration of the local anesthetic may occur due to disruption of the “pain
Are the diagnostic versus therapeutic value of the two injection approaches different?
This is a controversial topic. In general, the intra-articular approach may has a
greater therapeutic than diagnostic value. The medial branch block approach tends
to be more diagnostic rather than therapeutic. Often local anesthetic without corticosteroid
is used for the medial branch block approach. Although the local anesthetic only
last a few hours, patients will frequently have pain relief for much longer, possibly
due to disruption of the “pain cycle.”
What is involved when having a facet joint injection?
Before an injection, patient history and targeted examination are performed, patient’s
spinal imaging if available is reviewed, risks and benefits of the procedure discussed,
and signed consent is obtained.
The patient is then taken to our fluoroscopy (x-ray) suite and will lie flat on an
x-ray table. Pillows will be used to position the spine for comfort as well as to
provide optimal positioning for performing the procedure. The skin overlying the
injection sites are prepped (cleaned) in a sterile fashion and then sterile drapes
are placed around the prepped area.
The skin is then numbed with a local anesthetic. Under x-ray guidance a needle is
inserted. The needle is advanced under x-ray guidance to the targeted area. X-rays
pictures from different angles are used to ensure pin-point accuracy of the needle
tip. After the needle is placed properly, a small amount of contrast is injected
to ensure that the medication will go to the targeted area accurately as well as
to ensure patient safety. When optimal contrast flow is obtained, the medication
is injected. Additional needles are placed in similar fashion depending on how many
sites are being targeted.
The procedure including preparation time on average requires 20-30 minutes. Afterwards,
small Band-Aids are placed over the injection sites, post-procedure instructions
are given, and then the patient is monitored for 5-10 minutes before going home
What is expected after the injection?
Typically the injection site will be numb for 1-2 hours. After that, the injection
site is usually sore. Intermittent application of an ice pack to area is recommended
if the area is sore. A temporary mild increase in a patient’s symptoms may occur
until the effect of the corticosteroid takes place (usually within 2-3 days). The
corticosteroid will reduce the inflammation causing the patient’s pain. For medial
branch blocks with local anesthetic alone, pain relief beyond the duration of the
local anesthetic may occur due to disruption of the “pain cycle.”
What about additional injections?
At Loudoun Spine and Rehabilitation, we will perform follow-up injections depending
on the outcome of prior injections. Often only one or two injections are required
to substantially reduce a patient’s pain symptoms.
How long will the injections last?
For an intra-articular injection, although the effect of the corticosteroid is typically
only a few weeks, the patient may have pain relief for much longer. If the inflammation
causing the patient’s pain is significantly reduced, the pain may not come back.
For medial branch blocks with local anesthetic alone, pain relief beyond the duration
of the local anesthetic may occur due to disruption of the “pain cycle.”
If facet joint injections are effective in reducing a patient’s pain, albeit temporarily,
a more permanent treatment for facet joint pain called radiofrequency facet joint
neurotomy is commonly recommended. This procedure using heat from radiofrequency
energy to disrupt the nerve supply to the facet joints. Success with this procedure
can range from 6 months to 2 years.