Facet Joint Injection

What is a facet joint injection?

A facet joint injection is an injection into or around the joints that sit on either side of the vertebrae (bones) in the spine.

These small joints connect each spinal vertebra to adjacent from the neck (cervical spine) all the way down through the lower back (lumbar spine). The cervical spine has seven vertebrae. The first two (known as C1 and C2) each has three facet joints, while the remaining ones (C3-C7), as well as all of the thoracic and lumbar vertebrae have two facet joints each – one on either side of each bone. Although these joints are very small slits, they have similar makeup as larger joints like the knee or shoulder: They are lined with cartilage, encapsulated by a membrane called the synovium and, thus, vulnerable to arthritis and other joint injuries.

A facet joint injection can be injected either directly into or around these joints. When medicine is injected around the joint, the medication naturally goes into and surrounds the joint, which might be inflamed.

A 3D illustration of a facet joint injection.

Is a facet joint injection the same thing as a facet joint block?

Yes, facet joint injections and facet joint blocks are two terms that mean the same thing. To be more specific, there might be times when a doctor may inject medication into the facet joint versus around it into the medial branch nerves that supply the joint. However, both of those options are facet joint blocks, which is used as a blanket term.

Is a facet joint block the same as a steroid injection?

No. Steroid injections are a generalized term for any injection that contains corticosteroids. Facet joint injection refers to the location of an injection into or around the vertebral facet joints. However, steroids may be among the medications used in a facet joint injection.

What medicine is in a facet joint injection?

Facet joint injections usually contain only local anesthetics. On occasion, there may be some cortisone in the injections, but it depends on what the doctor is trying to achieve. Sometimes doctors perform facet joint injections for diagnostic purposes, while other times they do them for only therapeutic reasons to treat pain. When done for diagnostic reasons, a local anesthetic only is used, because the doctor is trying to determine whether the cause of the pain in the spine is coming from the facet joints. If the patient experiences improvement of their pain for a short amount of time, but then the pain relief wears off as the local anesthetic wears off, this indicates the facet joints are likely the cause of the pain. They can then do other things to make the pain control longer lasting.

What conditions can a facet joint injection treat?

Facet joint arthritis (which radiologists may label “joint arthrosis” or “arthropathy” in their imaging report) can be a stand-alone issue, especially if the patient has arthritis in other parts of the body.

But other spinal arthritis conditions can also cause it. For example, some athletes or former athletes develop minor osteoarthritis in the back from frequent contact sports, and most people experience some level of degenerative disc disease (DDD) as they age. This is when one or more vertebral discs in the anterior (front) undergo structural and functional changes through years of use. The corresponding loss of their cushioning can cause the facet joints at the posterior (back) of the spine to take on more load, which can make them inflamed (arthritic).

People with an inflammatory arthritis condition such as rheumatoid arthritis are more prone to facet joint arthritis, in some cases even as young as their early twenties. Sometimes, these pa/fs that demonstrate facet joint problems.

Who is a good candidate for a facet joint injection?

Facet joint injections are usually indicated for arthritis of the spine, a degenerated disc that is causing facet joint issues, or inflammatory arthritis that is affecting the spine. Typically, they are useful in people whose main pain complaint is axial back pain (low back pain) – as opposed to leg pain (“sciatica”) or in those with neck pain that is not radiating down the arm (cervical radiculopathy), if the facet joints are found to be a cause of their neck pain.

Who should not get a facet joint injection?

Patients who are not good candidates for facet joint injections are those who have primarily nerve-compression-related pain that extends down the arm or leg but with no pain in the neck or lower back. Also, if imaging shows that the spine architecture looks good, this could indicate a facet joint movement problem, but it may not necessarily be the best scenario for a facet joint injection.

How much do facet joint injections cost?

The cost of facet joint injections can vary. They are typically on the level of what an epidural steroid injection might cost and are typically covered by insurance. However, they often require prior authorization from the insurance company before they are performed.

How are facet joint injections performed?

Facet joint injections are performed under sterile conditions, typically, very similarly to how epidural steroid injections are done – in a small procedure room setting or small hospital setting (such as a “special procedures unit”) under image guidance – usually fluoroscopy (real-time X-ray guidance), although sometimes ultrasound- or CT-guidance may be used.

Patients usually do not undergo sedation for facet joint injections, except in some situations such as if a patient has a phobia of needles or is very sensitive to injections. It can be difficult (but not impossible) to get insurance to cover sedation for facet joint injections.

What type of doctor performs facet joint injections?

Facet joint injections are usually performed only by physicians that undergo additional specialized fellowship training to perform image-guided intraspinal procedures, which require a high level of expertise to be performed safely. Typically, these doctors are trained in sports medicine and in the spine and include interventional pain management doctors (who are also anesthesiologists), physiatrists, or interventional radiologists. Sometimes, doctors in other specialties, such as neurologists, may undergo a separate fellowship after neurology to learn how to do these kinds of injections.

How painful are facet joint injections?

To perform facet joint injections, doctors first inject local anesthetics to numb the area. There may be an initial sting at first while the local anesthetic is injected, but then the area becomes numb. Patients may then experience a sensation of pressure during the facet joint injection. Facet joint injections may be comparable to sensations experienced during an epidural steroid injection.

How should I prepare for a facet joint injection?

The preparation for facet joint injections depends on the doctor who is performing the injection. Some doctors may want patients to stop taking blood thinning medication for a certain number of days before the injection. Others may not.

If the patient will not be sedated, there is not much preparation they need to do before the procedure, and they can drive themselves home afterwards. If the patient will be sedated, they should follow their healthcare facility’s guidelines procedures involving general anesthesia. Such protocols generally include not eating for 6 to 8 hours before the procedure, although patients can usually have clear liquids up to four hours before.

Can I drive myself home after facet joint injections?

Most patients will not need to be sedated and can drive themselves home after the procedure. Patients who will be sedated will not be as awake or have the same level of consciousness as they normally would and will need someone to take them home.

How quickly can I return to activity? What should I not do after a facet joint injection?

Patients should not do heavy exercise such as intense cardio or weight training for at least 48 hours after facet joint injections. However, regular activity, such as basic activities around the house, are encouraged, because doctors want to see if these injections are helping patients with their regular daily activities. If the patient was previously experiencing pain during regular activity, but then they do not feel pain during these regular activities after facet joint injections, it can help doctors diagnose whether their pain is coming from their facet joints.

What is the recovery time after a facet joint injection?

Recovery after a facet block is fairly quick. There may be some soreness at the injection sites for a day or two. A patient will generally be very small bandages that can be removed the next day. Showering can be done the day after the injection, and light activity during the first 24 hours is okay. It is generally best to wait 48 hours before doing heavier activity, such as heavy lifting or intense cardio.

How long does the pain relief from a facet joint injection last?

The pain relief from facet joint injections generally goes in one of two directions. For some patients, relief may be short-lived, perhaps lasting about 48 hours. However, this can still be useful for diagnostic purposes. If the patient experiences pain relief greater than 70% to 80% for about 48 hours, a doctor then knows that a facet joint condition is source of pain. In this case, other procedures such as radiofrequency ablation can prolong the pain relief.

Other times, the pain relief from facet joint injections can last 3 to 6 months or even longer. In these cases, sometimes breaking the cycle of pain or inflammation is enough to help a patient continue with their rehab or exercise regimen that allows them to overcome their pain.

How often can you get a facet joint injection?

Typically, a doctor might only do one or two diagnostic injections. When facet blocks are therapeutic – meaning the pain relief lasts more than a couple of months – the frequency of receiving the injections is determined on a case-by-case basis.

Diagnostic injections can be performed very close together, such as a week or two apart. If the patient experiences pain relief from facet joint injections but the pain relief isn’t lasting, this typically means the pain is coming from the facet joints, but longer-lasting pain relief is necessary. In this case, it is common to progress to a procedure called radiofrequency ablation, which can provide pain relief for six months to a year. Radiofrequency ablations can be performed every six months if needed.

For therapeutic injections, insurance companies sometimes allow a patient to get facet joint blocks every couple of months, although every insurance policy is a little different. While not a safety issue, it is not appropriate to get facet joint injections more than twice in a 4- to 6-week period, because that means the pain relief is not lasting long enough. In such cases, it is often recommended to progress to a radiofrequency ablation.

Are there side effects with a facet joint injection?

The side effects of facet joint injections are generally very well tolerated but can include bruising, as well as increased pain or soreness for about a day after the procedure. Sometimes there is also minor bleeding.

If a steroid is included in the injection, there may be side effects specific to that medication, such as insomnia and/or feeling jittery for a day, or some redness or flushing in the face. People with diabetes may also experience a temporary rise in their blood sugars from the steroid.

What are the risks of facet joint injections?

The risks of facet joint injections are low. There is a risk of bleeding and infection as with all procedures that use needles, but it is a sterile procedure, so the risk of infection is very low.

Some doctors may ask their patients to stop any blood thinners a few days before the procedure to reduce the risk of any major bleeding.

While there is a low risk of nerve injury, it is extremely rare, since the needles are not entering the epidural space or around a nerve.

What is the success rate for facet joint injections?

For the right patients with the right indications – such as an X-ray or MRI clearly showing issues in the facet joints, along with the complaint of axial low back pain or axial neck pain – the success rate can be high, upwards of 80%. However, in cases where these indications are present but the spine also has severe arthritis, advanced curvature (scoliosis or kyphosis), or has otherwise experienced significant mechanical strain, a facet joint injection may not adequately relieve pain.

What is the next step if a facet joint injection doesn’t work?

If the pain relief is not lasting for a longer amount of time after a facet joint injection, the next step is typically a radiofrequency ablation procedure. When that works well, it can provide pain control that lasts six months to a year. Patients can then have this procedure done periodically. Unless there is an additional issue in the spine (such as disc degeneration), there is typically not much else that can be done for facet joint pain beyond these procedures, along with exercise and rehabilitation to support the muscle groups around them. Facet joints issues alone are typically not treated with surgery.

Posted: 12/20/2024

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