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Facet joint injections

A facet joint injection places anti-inflammatory medication directly inside a small spinal joint. It is used for pain thought to arise from that joint, particularly where inflammation is likely, and is performed under X-ray guidance.

Where a medial branch block numbs the nerves supplying a facet joint, a facet joint injection puts medication inside the joint itself. Both target the same structure by different routes.

When it is chosen. Intra-articular injection tends to be considered where an inflammatory process is likely — for example in inflammatory arthritis affecting the spine, or in an acutely irritable joint — rather than as a routine first step for mechanical facet pain. For most degenerative facet pain, the diagnostic block and radiofrequency pathway is better supported and Dr Martin will usually recommend that instead.

What the evidence shows. The evidence for intra-articular facet injection is weaker and less consistent than for the block-and-neurotomy pathway. Reported durations of benefit range from a few weeks to several months, with a meaningful proportion of people getting little response. This is worth knowing before you decide, and Dr Martin will be explicit about where your presentation sits.

On the day. You lie face down. Under X-ray guidance a fine needle is advanced into the joint; a small amount of contrast may be used to confirm placement. Local anaesthetic and anti-inflammatory medication are injected. The procedure takes around 20–30 minutes including preparation.

Afterwards. You may notice immediate relief from the local anaesthetic which then wears off within hours; this is expected. Any benefit from the anti-inflammatory component typically develops over several days. Soreness at the site for a day or two is common.

Risks. Whilst pain procedures are generally safe and well tolerated, all procedures carry risks. The specific risks relevant to you and your procedure will be discussed with you, and written information provided, before you decide to proceed.

Alternatives. Depending on your presentation these may include diagnostic medial branch blocks, radiofrequency neurotomy, targeted exercise and manual therapy, or medication review. Dr Martin will explain why one route is preferred over another in your case.