Facet Joint Injection – Injection Therapy for the Small Vertebral Joints to Treat Back Pain

The primary indication for facet joint injection is what is known as facet syndrome. This term refers to chronic pain in various areas of the spine caused by changes in the small vertebral joints (facet joints). 

Depending on where the spinal condition occurs, the symptoms can be diagnosed as

• cervical (neck),
• thoracic (chest spine), and
• lumbar (lower spine)

. However, most people affected suffer from pain in the lower back, which occurs primarily after prolonged walking or standing. The pain can radiate to adjacent areas of the body, such as the groin, hip, or thigh.

In some cases of chronic back pain, conservative treatment with pain medication and physical therapy is not successful. Here, too, a facet joint injection can help. The cause of the symptoms is often wear and tear of the joints and/or the intervertebral discs of the spine. This damage results from

• incorrect body mechanics during predominantly sedentary work,
• poor posture,
• lack of exercise, and
• excess weight.

Treatment via facet joint infiltration involves the injection of a local anesthetic. This is a medication that provides localized pain relief. In some cases, the doctor also administers a glucocorticoid (cortisone) to reduce inflammation.

The infiltration is performed with pinpoint accuracy using a thin needle into the facet joints or their immediate vicinity. The doctor monitors the injection site using X-ray or CT imaging to ensure that the surrounding nerve tissue is not compromised by the injection.

You can see the procedure for a facet joint infiltration in the following video:

The treatment is performed on an outpatient basis and takes only a few minutes. However, after the treatment, it is recommended that you remain in the treatment room for about 30 minutes and take it easy.

The effectiveness of the procedure depends on individual factors. Most patients notice a reduction in pain immediately after the first treatment. In some cases, however, multiple injections may be necessary until the symptoms disappear completely.

In addition to pain management, you must follow your doctor’s recommendations regarding physical therapy and proper spinal loading. Targeted physical therapy helps build muscle, strengthens the spine, and helps prevent joint damage.

In general, a facet joint injection performed by a specialist under visual guidance does not carry any particular risk. Complications and side effects occur only in very rare cases.

During the injection, blood vessels in the injection site may be injured, potentially leading to the formation of a hematoma. In most cases, hematoma formation does not require treatment. Very large hematomas that exert pressure on surrounding tissue may need to be surgically removed.

It is important to inform your doctor of any possible contraindications before the infiltration. These include medications or pre-existing conditions that would make a facet joint injection more risky. For example, a facet joint injection is considered too risky if

• taking anticoagulant medications (risk of hematoma formation),
• an existing infectious disease,
• pregnant women,
• people with certain heart conditions, or
• poorly controlled diabetes.

Injuries to adjacent structures such as nerves, nerve roots, or the spinal cord are very rare. They can lead to

• sensory disturbances,
• pain, or
• motor deficits

in the area innervated by the affected nerves. In most cases, however, these symptoms resolve on their own after a few days.

Using facet joint injection, the doctor injects active ingredients directly into the area of the facet joints, where they can take full effect © Matthieu | AdobeStock

After a facet joint injection, sensory disturbances and muscle weakness occur relatively frequently in the treated area. These are normal reactions to the treatment that usually subside within two hours.

It is best to schedule appointments for infiltrations so that there is sufficient time afterward for complete physical recovery.

Facet joint injections are a suitable therapeutic option for treating facet syndrome and chronic back pain if the pain symptoms have been evaluated by a specialist and other treatment methods have not yielded the desired results.

Specialists in orthopedics and musculoskeletal traumatology are the appropriate professionals to consult for individualized treatment of disorders of the spine and musculoskeletal system.

Occupational therapy and physical therapy measures are suitable for supplementing and supporting specialist medical treatment.

What is a facet joint injection?

A facet joint injection is a form of injection therapy in which medication is injected directly into the facet joints of the spine. It is used to relieve back pain originating from the small vertebral joints.

How is the procedure performed?

The treatment is performed on an outpatient basis using a fine needle under imaging guidance, such as CT or X-ray. An anesthetic, often combined with an anti-inflammatory medication, is injected.

When is a facet joint injection recommended?

A facet joint injection is indicated for degenerative changes, osteoarthritis of the facet joints, or chronic back pain. It can also be used diagnostically to pinpoint the cause of the pain.

How long does the effect last?

The effects can last for varying lengths of time, ranging from several days to several months. For many patients, the effects are long-lasting, especially when combined with physical therapy.

What are the risks or side effects?

Facet joint injection is considered a safe procedure with minimal risks. In rare cases, mild pain at the injection site, irritation, or short-term side effects may occur; serious complications are rare.