What Is Facet Joint Injection?
Each vertebra in your spine connects to the one above and below it through a pair of small facet joints, one on each side. Like other joints, facet joints are lined with cartilage and can develop arthritis, get inflamed or be strained. Facet pain usually stays in the back or neck, can spread to the buttocks or shoulders, and often feels worse when you lean back, twist or stand for a long time.
There are two common types of facet procedure:
- Intra-articular facet injection: medicine is placed directly inside the joint.
- Medial branch block: a small amount of numbing medicine is placed next to the medial branch nerves, the tiny nerves that carry pain signals from the facet joint.
Medial branch blocks are mainly diagnostic. If your usual pain drops substantially for the few hours the numbing medicine lasts, the facet joints are likely a main pain source, and you may be a candidate for radiofrequency ablation, which can give longer relief.
Performed under live X-ray (fluoroscopy) guidance in our in-office procedure room.
Who Is a Candidate?
You may be a candidate if you have back or neck pain that has lasted for weeks to months, has not improved enough with medication and physical therapy, and your exam suggests the facet joints. Pain that stays mostly in the back or neck, rather than shooting down a leg or arm, points toward the facets.
Dr. Baskin reviews your imaging, such as X-ray or MRI done in our office, and your exam before recommending an injection. Let us know about blood thinners, diabetes, infections and allergies to contrast dye ahead of time.
What to Expect
You lie face down on the procedure table. The skin is cleaned and numbed, and Dr. Baskin uses fluoroscopy, a live X-ray, to guide a thin needle to each targeted joint or nerve. A small amount of contrast dye confirms the position before the medicine is injected. Several levels can be treated in one visit.
After a medial branch block, we ask you to move around and keep a simple pain diary for the next several hours. Your notes tell Dr. Baskin how much of your pain came from the facet joints, which guides the next step. Plan to have someone drive you home.
Risks and Side Effects
Facet injections are generally well tolerated. Possible risks include:
- Soreness at the injection sites for a day or two
- A temporary increase in pain
- Short-term side effects of the steroid, such as flushing, trouble sleeping or higher blood sugar in people with diabetes
- Rare risks such as infection, bleeding or nerve irritation
Recovery
Most people return to normal activity the next day. The numbing effect lasts hours. If a steroid is used, it usually starts to work within a few days, and relief can last from weeks to months. Results vary.
Because our physical therapy team works in the same office and shares your chart, you can start or resume therapy soon after. Core strength, posture and flexibility work help protect the facet joints over the long term.
Physical therapy happens in our office, with therapists who share your chart. Learn about on-site physical therapy.
Insurance and Cost
Medicare and most commercial PPO plans usually cover diagnostic medial branch blocks when criteria are met, such as a period of documented pain and a trial of conservative care. Coverage for facet injections given for ongoing relief rather than diagnosis is more limited, and Medicare covers them only in specific situations. Many plans limit how often they can be repeated, and some require prior authorization. HMO plans need a referral from your primary care physician before your visit. Our team verifies your benefits when you call.
When to Talk to a Specialist
Call our office if back or neck pain lasts more than a few weeks, keeps you from sleeping or working, or keeps coming back.
Go to the emergency room or call 911 if you have loss of bladder or bowel control, numbness in the groin, or sudden severe weakness in your legs or arms.
