A facet joint injection puts corticosteroid inside the small paired joints at the back of the spine.
What is a facet joint injection?
A medial branch block aims at the nerves that feed the joint. This aims at the joint itself. It is used to confirm the joint as a pain source. It is also used to calm inflammation inside it.
PRP and the other orthobiologics we use for the low back and pelvis are explained on our PRP injections in St. Louis page.
What is a facet joint injection used for?
- Facet arthropathy in the neck or low back
- Neck pain worse on extension and rotation
- Joint inflammation after an accident
What happens during a facet joint injection?
- Performed under fluoroscopy with contrast confirmation.
- Takes 10 to 20 minutes.
- Local anesthetic gives early relief. The steroid effect builds over several days.
- No sedation; most patients drive themselves home.
What are the risks of a facet joint injection?
Putting steroid inside a small synovial joint carries a low but real risk of septic arthritis (a joint infection). That is why our germ-free technique is strict. It is also why you must report pain that keeps rising with a fever the same day. A short rise in pain for one to two days is common, because the joint capsule gets stretched. Whole-body steroid effects apply here too: higher blood sugar, flushing and poor sleep.
To talk about whether this is right for you, call us or request an appointment.
How we judge whether it worked
This has a different goal than a medial branch block. The block numbs the nerves that feed the joint. It is mainly a test. The injection puts medication inside the joint. It is mainly a treatment.
Where intra-articular injections (shots inside the joint) give good but short relief, that is a reason to move on. The next step is medial branch blocks and ablation. That is better than repeating the injection forever.
Before and after your procedure
No sedation is used, so most patients drive themselves home, and normal activity, including work, resumes within two to four hours. Expect a day or two of extra soreness as the joint capsule settles. This is common and not a sign of failure. Steroid may raise blood sugar for several days. If you have diabetes, check it more closely than usual. Report pain that keeps rising with a fever the same day. Joint infection is rare, but it is the one problem that must not be missed.
How the procedure is actually done
A facet joint injection puts medication into the joint capsule itself under fluoroscopic guidance (live X-ray). A medial branch block is different. It numbs the nerves that feed the joint from outside it. Both deal with the same joint. Which one we use depends on the goal. One goal is diagnosis toward ablation. The other is relief for an inflamed joint.
Who it suits, and who it does not
It suits facet-pattern pain where the goal includes treating inflammation. This pain is worse when you arch back or twist and better when you bend forward. It often sits just beside the middle of the spine. When the goal is to establish whether ablation would help, medial branch blocks are the better test. That is because the ablation targets those nerves, not the joint space.
What the evidence supports, and what it does not
Honesty matters here. Some of these procedures have strong evidence behind them. Some have moderate evidence in well-chosen patients. Choosing the right patients is usually what separates the studies that show benefit from those that do not. We will tell you which group your proposed procedure falls in. Where the evidence is mixed, we will say that too.
Common questions
How is this different from a medial branch block?
The block numbs the nerves to the joint and is mainly a test. It is what predicts ablation. The injection puts medication in the joint and is mainly a treatment. They answer different questions.
Medial Branch Block goes through it in detail.
How long does it last?
Weeks to months when inflammation is the cause. Short relief still shows the joint is the source, and that is useful.
Does it need imaging guidance?
Yes. These are small joints sitting close to nerve structures and blind injection is not accurate. Its result cannot be read either.
Is a facet joint injection the same as a cortisone shot?
It uses the same family of medicine, a corticosteroid. But where it goes is what makes it a facet joint injection. The medication goes inside one small joint at the back of the spine. It is placed under fluoroscopy, with contrast dye confirming the spot. A local anesthetic gives early relief. The steroid effect builds over several days. A blind injection into these joints is not accurate, and its result cannot be read.
What is the next step if facet joint injections don’t work?
If the injection gives good relief that does not last, that is still useful. Short relief shows the joint is the source. The next step is then medial branch blocks and radiofrequency ablation. Repeating the joint injection forever is not the answer. The blocks are the better test for ablation because ablation treats the nerves that supply the joint, not the joint space.
What should I expect after a facet joint injection?
No sedation is used, so most patients drive themselves home, and normal activity, including work, resumes within two to four hours. Expect a day or two of extra soreness as the joint capsule settles. It is common and not a sign of failure. The steroid may raise blood sugar for several days. If you have diabetes, check it more closely than usual. Report pain that keeps rising with a fever the same day, because joint infection, though rare, must not be missed.
Sources
- Cohen SP et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Regional anesthesia and pain medicine, 2020. PubMed 32245841
- Manchikanti L et al. Comprehensive Evidence-Based Guidelines for Facet Joint Interventions in the Management of Chronic Spinal Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines Facet Joint Interventions 2020 Guidelines. Pain physician, 2020. PubMed 32503359
- Du R et al. Facet Joint Syndrome: Pathophysiology, Diagnosis, and Treatment. Journal of pain research, 2022. PubMed 36474960
- Han CS et al. Low back pain of disc, sacroiliac joint, or facet joint origin: a diagnostic accuracy systematic review. EClinicalMedicine, 2023. PubMed 37096189
Hurt in an accident? Start here.
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Monday–Friday, 8:00 a.m. – 4:00 p.m. Same-day appointments are often available for new accident and injury patients.