Facet Joint Injections

These are spinal injections where medications are injected into facet joints.  Facet joints are very small joints in the spine that connect the vertebrae bones of the spine. They are also known as zygapophyseal joints. Each spinal level has two (one on the left and one on the right). These can be performed in the cervical spine, thoracic spine, and the lumbar spine to treat neck pain, mid to upper back pain, and lower back pain respectively. These injections are typically for neck and back pain that is nonradicular , meaning the pain does not travel down the arms or legs and is not associated with numbness, tingling, or “sciatica.”  In the cervical spine facet injections may also help treat certain types of headaches (cervicogenic headaches). 

What is being injected?

Facet injections can be either diagnostic or therapeutic.  When diagnostic, the only purpose is to help confirm or rule out spinal facet joint(s) as a cause of one’s neck or back pain. In this case the only medication injected is an anaesthetic (lidocaine, xylocaine, bupivacaine, etc) which temporarily anesthetizes (numbs) the targeted joint. Whether or not the pain is completely or significantly reduced during the time that the numbing medicine is active will help establish the diagnosis.  In therapeutic facet joint injections the medication injected is usually a steroid (dexamethasone, depomedrol, kenalog, etc) often mixed with an anesthetic. The purpose here is mainly for pain relief more than for diagnostic reasons. 

What it does

Helps reduce pain and inflammation from painful spinal facet joint(s). Like other joints in the body facet joints are covered by a joint capsule, lined by cartilage and have joint fluid inside. Facet joints can develop wear and tear and arthritis just like other joints and may become swollen and painful resulting in neck and back pain. Depending on which joint is affected the pain can refer to different places such as hips, buttocks, shoulder blades, and back of the head. 

What it doesn’t do

Facet joint injections (with steroid and/or anesthetic) do not heal, treat, or reverse arthritis or any injury to the facet joint. The only benefit is reducing inflammation and pain in the joint when steroid is injected. In case of diagnostic facet joint injections the benefit is confirming or ruling out the cause of pain.  In that sense facet injections do not “fix the problem.” They also do not have any way of preventing pain from returning in the future. They are strictly meant for alleviating or diagnosing pain from spinal facet joints. Pain relief is usually short term (varies from weeks to months).

Then why do them?

Usually recommended when pain is very severe, uncontrolled by medications, unable to tolerate exercise or physical therapy, and when surgery could be avoided or not indicated. Most specialists do not recommend facet joint injections for chronic facet pain as pain relief is much less likely. At this point medial branch blocks followed by radiofrequency ablation is more likely to result in pain relief.   Facet injections allow quick resolution of pain for a period of time during which the injury may heal itself and this is why the pain may not return. To prevent further reinjuries or return of pain the patient should develop a regular core strengthening exercise program and be educated on ways to avoid reinjury.

What are the risks?

Overall considered safe when performed with fluoroscopic (xray) guidance by a physician specialized in interventional pain management. Preferably one who is  board certified and fellowship trained. Risks are similar to other spine interventions and include spinal headache, infection, bleeding, allergic reaction, pain aggravation, nerve injury, and paralysis (rare).