Facet joint injections aim to reduce spinal facet joint pain through targeted delivery of anesthetic and/or steroid medication directly into the joint., They provide a minimally invasive option to manage facet joint pain compared to spinal surgery.
Facet joint injections are performed in an outpatient setting, such as an office-based surgical suite or outpatient surgical center, and in most cases, patients are able to return to their normal activities the next day.
In This Article:
- Cervical, Thoracic, and Lumbar Facet Joint Injections
- Facet Joint Injection Procedure
- Facet Joint Injection Potential Risks and Complications
- Facet Joint Injections Procedure Video
Pain Originating from a Facet Joint
Facet joints are small, paired joints in the spine that facilitate movement and stability.
Facet joints are a pair of small joints that connect each segment of the spine at the back. They provide stability and help guide motion within the segment. Spinal arthritis, trauma, and increased mechanical stress are the most common causes of facet joint pain (also referred to as facet joint disorder).
Research indicates that about 70% of neck pain and 50% of back pain involves the facet joints.
- Cervical facets cause pain in the head, neck, shoulders, and arms, as well as headaches
- Thoracic facets affect the upper and mid back and chest
- Lumbar facets cause pain in the low back area, hips, buttocks, and legs
Facet joint pain may be localized or radiate to adjacent areas as described above.
Goals of Facet Joint Injections
Facet joint injections reduce inflammation and control painful symptoms.
Facet joint injections serve diagnostic and therapeutic purposes, and are used to confirm the involvement of facet joints as the source of pain and provide targeted pain relief.
- Diagnostic. A diagnostic facet joint injection (also referred to as a facet block) is used to pinpoint spinal facets as a pain generator. In this injection, an anesthetic is injected into the facet joint to block nerve pain signals, and a positive response (at least 80% improvement in pain) typically confirms that the joint is the source of spinal pain.,
- Therapeutic. A therapeutic facet joint injection treats spinal pain originating from the facets. In this injection, a combination of anesthetic and corticosteroid medications is injected into the joint to provide extended pain relief. The anesthetic temporarily blocks pain signaling until the corticosteroid takes effect and reduces inflammation.,
The pain relief from a facet joint injection is intended to help a patient better tolerate activities and a physical therapy routine to rehabilitate his or her injury or back condition.
When Facet Joint Injections are Recommended
Conditions such as facet joint arthritis can be treated with facet joint injections.
Candidates for facet joint injections include patients who have experienced moderate to severe facet pain lasting 3 months or longer and who have not responded to non-surgical treatments, such as pain-relieving medication and physical therapy.,
Common conditions treated by facet joint injections
Facet joint pain is associated with several arthritis and spinal conditions, including,,:
- Facet joint osteoarthritis
- Spinal osteoarthritis
- Degenerative spondylolisthesis
- Rheumatoid arthritis
- Ankylosing spondylitis
- Scoliosis
Facet joint pain arises from inflammation, swelling, and/or the erosion of cartilage in the joints in these conditions.
When Facet Joint Injections May Not be Recommended
Facet joint injections are not used for non-facet pathologies like fractures.
These injections should also be avoided in the following circumstances due to the significantly increased risk of complications,:
- Active infection (systemic or local)
- Bleeding disorders
- Allergies to medications used or imaging contrast
- Progressive neurological conditions
- Pregnancy
Additionally, facet joint injections are not utilized in the treatment of non-facet pathologies, such as fractures, tumors, or infections.,
Types of Facet Joint Injections
Facet joint injections involve precisely placing a thin needle into a facet joint with imaging guidance techniques, such as fluoroscopy (live x-ray) or ultrasound.,
| Injection Type | Where the injection is given | Purpose |
|---|---|---|
| Intra-articular injection | Into the intra-articular space (the space within the facet joint capsule) | Diagnostic and Treatment |
| Medial branch nerve block | Near the medial branch nerves of the suspected facet joint | Primarily diagnostic |
Medications Used in Facet Joint Injections
The anesthetics commonly used in facet injections include:
- Bupivacaine
- Lidocaine
- Ropivacaine
Using these medications in any intra-articular injections (such as facet, hip, and knee) is considered off-label as they potentially cause damage to the cartilage in joints. However, this effect has only been seen with infusions of the medications over several hours, and it has yet to be demonstrated in facet joint injections.,
The commonly used corticosteroids for facet injections are:
- Triamcinolone
- Dexamethasone
- Methylprednisolone
- Betamethasone
Dexamethasone is preferred in thoracic and cervical injections due to the lower risk of drug particles causing blockages in blood vessels (embolism). These medications are FDA-approved in the US for intra-articular injection.,
Additional types of therapeutic facet joint injections
Concentrated PRP is injected to reduce inflammation and promote natural healing in facet joints.
Alternative compounds used in facet injections to improve joint mobility and reduce pain include:
- Hyaluronic acid injection. Hyaluronic acid is injected into the facet joint’s outer capsule to lubricate the articular surfaces and relieve pain by reducing friction.
- Platelet-rich plasma injection. A concentrated form of the patient's own blood, which is rich in healing platelets, is injected into the facet joints to reduce inflammation and promote the natural healing of damaged tissues. Early studies support the effectiveness of platelet-rich plasma for treating facet joint pain, but more research is needed to establish the long-term efficacy of this treatment.
Additionally, researchers are investigating the effectiveness of biological substances, such as bone marrow stem cells, and plant-derived compounds, such as sarapin, for facet joint injections.
Accuracy of Diagnostic Facet Joint Injections
The usefulness of a facet joint block in correctly diagnosing facet-mediated pain varies based on injection technique, spinal region, underlying pain conditions, and additional patient-specific factors.,
Medial branch nerve blocks are the preferred over diagnostic facet joint injections because they are more accurate. However, there is still a high potential for false-positive responses, meaning a patient experiences pain relief due to an incorrect injection into a nearby symptomatic nerve root or spinal disc instead of the facet joint.,
Performing a second block 2-3 weeks later at the same level is strongly recommended to confirm that the targeted facet joint is the source of pain.,
Success Rates of Therapeutic Facet Joint Injections
Facet joint injections relieve pain and improve mobility in approximately 50% to 75% of patients. However, the extent and duration of relief varies widely between patients depending on the type of injection and individual factors (eg, disease severity or accuracy of diagnosis).,
Intra-articular injections typically provide short-term relief for around 2-4 months.,
