The spine is made up of bones called vertebrae. Each vertebra has two pairs of facet joints. One pair points up and connects with the vertebrae above. The second pair points down and connects with the vertebrae below.
These joints have cartilage, ligaments, and a surrounding sac of fluid to allow smooth movement. Injury to any of these structures may cause swelling and pain. The swelling may also put pressure on nerves as they exit the spinal cord. This may result in local pain or pain that shoots down the limbs.
A facet joint injection is a shot directly into the joint. The shot will have a small amount of a numbing medication (anesthetic) and/or medication to reduce swelling.
In some cases, the injection is done just beside the joint at a tiny nerve branch that supplies the joint. This is called a medial branch block. This is often done as a diagnostic test with just a numbing medication to see if the targeted area is the source of pain.
Facet Joint Injection
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It is not always clear what causes back or neck pain. It may be caused by problems of the joint, nerves, or other structure, such as muscles or ligaments. A facet joint injection of a numbing medication may be used to confirm or disprove the joint as the cause of pain.
If the facet joint is the cause of pain, injections may be used to deliver steroid medication to try to help control pain and inflammation.
Potential problems are rare. But, all procedures have some risk. Your doctor will review potential problems, like:
bruising, or bleeding at the injection site
InfectionWorsening of painLightheadednessAllergic reaction to the medication usedNerve injuryMuscle weaknessHeadache
may increase your risk of complications.
Your doctor may
want to do this injection if you: Have had pain for a short time (less than 6 weeks)Have not tried other conservative treatmentHave had success with conservative treatmentHave allergies to the local anesthetic, x-ray contrast, or medications being usedHave a bleeding disorder or take blood thinning medicationHave pain that is due to an infection or malignancy
high blood pressure
Your doctor may begin with conservative treatment, such as rest, medication, physical therapy, and exercise.
Before the procedure you may need: A physical exam
Imaging tests to evaluate the spinal structures with
MRI scanTo discuss allergies that you may have to the anesthetic, pain medication, or latex
In addition, talk to your doctor about your medications. You may have to stop taking some medications up to one week or more before the procedure.
Additional considerations include: Your doctor may ask you to avoid food or drink a few hours before the procedure.You will need someone to drive you home after the procedure.
You will be awake during the procedure. A local anesthetic will be used to numb the skin before the injection. Your doctor may also give you additional medication to help you relax.
You may have devices attached to help monitor your blood pressure, heart, and oxygen levels. You will be asked to lie on your stomach or side on an x-ray table. The skin around the injection site will be cleansed with an antiseptic. A local anesthetic may be given to numb the area.
The doctor may inject a contrast dye. This dye will help to highlight the joint in an x-ray and help ensure the correct placement of the injection. This type of x-ray is called a fluoroscopy. The doctor will place the needle into or around the joint and inject the anesthetic medication. You will be asked about your pain relief during the procedure.
If you have pain relief after the injection, this may mean the problem is due to the facet joint. A second injection with a steroid medication may be done to reduce inflammation and swelling.
If you do not have pain relief after the first injection, your doctor may: Try another facet jointInject more medicationTry an alternative spine injection
You will stay at the clinic for up to 30 minutes after the injection.
The injection only takes a few minutes. The entire visit may be 30-60 minutes. The length of time will depend on the number of injections needed and how you recover.
This is a deep injection so you may have some discomfort. Ask your doctor about medication to help with the pain after the procedure.
You may have complete or partial pain relief.
Your doctor will assess your level of pain relief. You may be asked to do movements that had been causing pain before. This can help to see if you feel better after the injection.
You might feel some numbness, weakness, or tingling for a few hours after the injection. You may need to avoid certain activities. You can slowly increase your activity as tolerated or by your doctor's instructions. You can apply ice to the affected area to relieve swelling and discomfort. Pain can be managed with medications. Proper care of the insertion site can help prevent infection. If you have diabetes, monitor your blood sugar levels more carefully a few weeks after an injection. The medication that was injected may cause elevated blood sugar levels.
It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor: Redness, swelling, increasing pain, bleeding, or discharge from the injection siteNausea or vomitingSevere pain or headacheFever or chillsLoss of bladder or bowel controlProgressive weakness or numbness
If you think you have an emergency, call for medical help right away.
Lumbar zygapophysial (facet) joint injections. North American Spine Society Know Your Back website. Available at:
http://www.knowyourback.org/Pages/Treatments/InjectionTreatments/LZJ_Injections.aspx. Created June 28, 2009. Accessed March 23, 2017.
Spinal injections. American Academy of Orthopedic Surgeons Ortho Info website. Available at:
http://orthoinfo.aaos.org/topic.cfm?topic=A00560. Updated December 2013. Accessed March 23, 2017.
Spinal injections. Rehabilitation Institute of Chicago website. Available at:
http://www.ric.org/conditions/sportsmed/SpinalInjections.aspx. Accessed March 23, 2017.
Last reviewed March 2017 by Michael Woods, MD FAAP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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