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Facet Joint Procedures

What is facet joint pain?

  • Facet joints are tiny joints located between the bones of your spine (the vertebrae). They function in bending and twisting your back and neck.
  • Typically felt in the low back (lumbar facet joints) or neck (cervical facet joints).
  • Sometimes these joints can cause “referred” pain that is felt in the hips, thighs or upper back. They do NOT cause “sciatica” in most cases.
  • After whiplash injury, injury to the facet joints in your neck can cause headaches in addition to neck pain.
  • Pain from these joints can occur in conditions including osteoarthritis and rheumatoid arthritis but also after trauma such as a motor vehicle accident, a condition known as “traumatic arthritis.”
  • The pain from the facet joint is carried by the medial branch nerve from the joint itself to your spinal cord and then the brain.
The arrow is pointing to a facet joint, which is inflamed and could be causing pain. We figure out if the facet joint is responsible for your pain by doing a nerve block, as described below. (credit: wikimedia commons)

What is a facet joint injection?

  • The purpose of this injection is to diagnose pain stemming from a facet joint by injecting a numbing medication (local anesthetic) to block the nerve that gives that joint sensation. This may be called a “facet joint injection” or “medial branch block.”
  • Your provider will use x-ray to perform this injection.
  • Sometimes this procedure can provide prolonged pain relief of low back or neck pain. However, quite often, the injection is diagnostic (meaning that it confirms that your pain is due to the facet joint) but does not provide lasting pain relief. In this scenario, an additional procedure, radiofrequency ablation, may be appropriate.

Post-Procedure:

  • Since this injection is diagnostic, we encourage you to walk around or do other activities that typically provoke or worsen your pain after the procedure. These activities may include standing, bending over, doing household chores or twisting.
  • Remember, a diagnostic injection may only last a couple of hours – do not worry, this is expected.
  • You may need a ride home after your injection, please ask the clinic if you have questions about this.
  • Mild bruising and soreness around the injection site may occur. 
    • Applying ice for a few days may reduce inflammation and pain
    • Continue to take your regular pain medication
  • You will be asked to use a pain diary after the injection. Recording pain levels for a few days after the procedure will help to track the level of relief achieved.

Risks:

  • Potential risks with inserting a needle include bleeding, infection, pain flare, allergic reaction, headache, and nerve damage (rare). 
  • Please notify the provider if the injection site becomes infected (fever or drainage at the injection site) or inflamed (redness, swelling, pain at the site), or if you suspect nerve injury.