Cervical, Thoracic & Lumbar Facet Joint Injections

What Are Facet Joint Injections?

Facet joint injections are a type of minimally invasive interventional pain treatment used to help diagnose and manage pain that arises from the small joints of the spine, called facet joints. These joints are located at each level of the spine (neck, mid-back, and lower back) and help guide movement and maintain spinal stability. When they become irritated or inflamed, often from wear, arthritis, or repetitive stress, this can lead to localized back or neck pain and stiffness.

A facet joint injection delivers a combination of local anesthetic and anti-inflammatory medication (typically a corticosteroid) directly into or around the facet joints or the nerves that supply them. This can both reduce inflammation and provide pain relief. Because facet joint pain can be difficult to distinguish from other spinal pain sources, these injections are often used for diagnosis as well as treatment. If pain significantly improves after the injection, it helps confirm the facet joints as the source of the discomfort.

How the Procedure Works

Facet joint injections are typically performed on an outpatient basis using imaging guidance (such as fluoroscopy or CT) to ensure precise needle placement into the appropriate joints. You’ll lie comfortably on the procedure table while a local anesthetic numbs the skin and deeper tissues. A fine needle is then guided into the facet joint or near the medial branch nerves that supply it, and the medication is injected.

The procedure usually takes about 10–20 minutes. Many patients go home the same day and can resume most normal activities within 24 hours, although strenuous activity is often limited for a few days after the injection.

Conditions Treated

Facet joint injections can help patients with pain stemming from:

• Neck pain related to cervical facet irritation

• Mid-back pain from thoracic facet inflammation

• Low back pain caused by lumbar facet joint degeneration or arthritis

• Pain that is worse with extension, twisting, or long periods of standing or sitting

• Facet joint arthritis or mechanical pain not fully relieved by conservative treatments such as medication and physical therapy

These injections are often considered when other non-invasive approaches have not provided sufficient relief.

What to Expect After the Injection

Some patients experience immediate relief from the local anesthetic, while the full benefit of the steroid medication may take several days to develop. The duration of pain relief varies, and some patients may feel relief for several weeks to months. Facet injections can also allow patients to participate more comfortably in physical therapy and rehabilitation.

Because these injections can both treat and help confirm the source of pain, they are often used as a step in determining the best long-term pain management plan. If facet joint injections are helpful but symptoms return, other options, like radiofrequency ablation, may be discussed.

Risks and Side Effects

Facet joint injections are generally well tolerated, and serious complications are uncommon. Nevertheless, as with any procedure involving needle placement, there are some risks:

• Temporary soreness or tenderness at the injection site

• Brief increase in pain after the procedure

• Minor bleeding or bruising

• Infection (rare)

• Temporary numbness or weakness

• Temporary increase in blood sugar in patients with diabetes

More serious complications, such as nerve injury or joint infection, are rare, especially when the procedure is performed using image guidance and sterile technique.

Who Is a Good Candidate?

Facet joint injections may be recommended for individuals who:

• Have chronic spinal pain localized to a specific region (neck, mid-back, low back)

• Have not found adequate relief with conservative treatments like medications, therapy, or activity modification

• Have clinical or imaging findings that suggest facet joint inflammation or degeneration

• Are seeking a diagnostic evaluation to pinpoint the pain source

Your clinician will review your symptoms, physical examination, and imaging before recommending this procedure.

Reference

Content adapted from multiple clinical sources including Cleveland Clinic, StatPearls, and RadiologyInfo.org:
https://my.clevelandclinic.org/ (facet joint injections) and NCBI https://www.ncbi.nlm.nih.gov/books/NBK572125/