What Are Facet Joint Injections?

Facet joints (also called zygapophyseal joints) are the small joints located at the back of each vertebra that help stabilize the spine and allow movement. When these joints become inflamed or arthritic, they can cause significant neck or back pain.

A facet joint injection delivers a local anesthetic and usually a corticosteroid directly into or around the painful facet joint. The anesthetic can provide immediate diagnostic information, while the steroid aims to reduce inflammation for longer-lasting relief.

These injections are almost always performed with fluoroscopic (live X-ray) guidance to ensure accurate needle placement.

Why Might I Need a Facet Injection?

Your doctor may recommend a facet joint injection if you have:

• Axial (central) neck or back pain that is worse with extension or rotation
• Pain suspected to come from the facet joints (often after imaging or examination)
• Pain that has not improved adequately with medication, physical therapy, or other conservative care
• A need to confirm that the facet joints are the source of pain before considering longer-term treatments such as radiofrequency ablation (medial branch neurotomy)

Relief from a facet injection can last from days to several months. If the injection provides significant temporary relief, it may support moving forward with radiofrequency ablation for longer-lasting results.

How Do I Prepare?

Typical preparation includes:

• Medications: Tell your doctor about all medications, especially blood thinners. Certain blood thinners may need to be stopped for a short period (only as directed by your physician).
• Eating & drinking: Most patients can eat and drink normally unless sedation is planned.
• Clothing: Wear comfortable clothing that allows easy access to the neck or back.
• Allergies: Inform the team of any allergies to local anesthetics, steroids, or contrast dye.
• Transportation: Arrange for someone to drive you home if you receive sedation or prefer not to drive afterward.

How Is the Procedure Performed?

The procedure is performed in an outpatient setting and usually takes 15–30 minutes.

Typical steps:

1. You lie face-down on the procedure table. The skin over the target area is cleaned with an antiseptic solution.
2. The provider uses local anesthetic to numb the skin.
3. Using live X-ray (fluoroscopy) guidance, a thin needle is carefully advanced into the facet joint.
4. A small amount of contrast dye is injected to confirm that the needle is correctly positioned inside the joint.
5. A mixture of local anesthetic and corticosteroid is injected into the joint.
6. The needle is removed, and a small bandage is applied. Multiple levels can be treated in the same session if needed.

What Should I Do for Aftercare?

Immediate Care

• You will be monitored briefly after the procedure.
• You can usually go home the same day.
• The local anesthetic often provides rapid pain relief that may last several hours.

Activity Guidelines

• Rest and avoid strenuous activity, heavy lifting, or prolonged sitting/standing for the remainder of the day.
• Gradually return to normal activities as comfort allows over the next 1–2 days.
• The steroid typically begins working within 1–3 days (sometimes up to a week).

What to Expect

• A temporary increase in pain is possible for a day or two after the injection.
• Your doctor may ask you to keep a simple pain diary for the first few hours or days — this helps determine whether the facet joints are truly the source of your pain.

What Are the Risks?

Facet joint injections are generally safe when performed with image guidance by experienced physicians. Possible risks include:

• Temporary increase in pain or soreness at the injection site
• Infection or bleeding (rare)
• Allergic reaction to the medication or contrast
• Temporary numbness or weakness
• Incomplete or short-lived pain relief

Your physician will discuss the specific risks and benefits for your situation.

When Should I Call My Doctor?

Contact your healthcare provider if you experience:

• Increasing redness, swelling, warmth, or drainage from the injection site
• Fever
• Severe or worsening pain
• New or prolonged numbness, weakness, or difficulty moving
• Any other concerning symptoms