Facet Joint Injections
Thoracic and Lumbar Facet Joint Injections
Facet Joint Injection FAQ
Facet joints are small joints at each segment of the spine
that provide stability and help guide motion. The facet
joints can become painful due to arthritis of the spine, a
back injury or mechanical stress to the back. A cervical
(neck), thoracic (upper back) or lumbar (lower back) facet
joint injection involves injecting a steroid medication,
which can anesthetize the facet joints and block the pain.
The pain relief from a facet joint injection is intended to
help a patient better tolerate a physical therapy routine to
rehabilitate his or her injury or back condition.
joint injections usually have two goals: to help diagnose
the cause and location of pain and also to provide pain
- Diagnostic goals: By placing numbing medicine
into the joint, the amount of immediate pain relief
experienced by the patient will help confirm or deny the
joint as a source of pain. If complete pain relief is
achieved while some of the facet joints are numb it
means those joints are likely to be the source of pain.
- Pain relief goals: Along with the numbing
medication, a facet joint injection also includes
injecting time-release cortisone into the facet joints
to reduce inflammation, which can often provide long
term pain relief. The procedure may also be called a
facet block, as its purpose is to block the pain.
Anatomy of the Cervical,
Thoracic and Lumbar Facet Joints
The facet joints are paired joints in the back and neck,
one pair at each vertebral level (one joint on each side of
the vertebrae). These joints have opposing surfaces of
cartilage (cushioning tissue between the bones) and a
surrounding capsule that is filled with synovial fluid,
which reduces the friction between bones that rub together.
Cervical facet joints are located on the back or side of
the neck. Thoracic facet joints are in the upper back and
lumbar facet joints are in the lower back. Depending on
which joints are affected, pain can be located in different
areas of the body:
- Cervical facet joints. Pain caused by
cervical facet joints is usually felt in the head, neck,
shoulder, and/or arm.
- Thoracic facet joints. Pain caused by
thoracic facet joints is typically felt in the upper
back, chest and/or arm (rarely).
- Lumbar facet joints. Pain cause by lumbar
facet joints is typically felt in the lower back, hip,
buttock, and/or leg.
Cervical, Thoracic and
Lumbar Facet Joint Injection Procedure
As with many spinal injections, facet joint injections
are best performed using fluoroscopy (live x-ray) for
guidance to properly target and place the needle (and to
help avoid nerve injury or other injury).
The injection procedure includes the following steps:
- An IV line will be started so that adequate
relaxation medicine can be given, if needed.
- The patient lies face down on an x-ray table and the
skin over the area to be treated is well cleaned.
- The physician numbs a small area of skin with an
anesthetic (a numbing medicine). This may sting for a
- The physician uses x-ray guidance (fluoroscopy) to
direct a very small needle into the joint. Several drops
of contrast dye are then injected to confirm that the
medicine only goes into the joint.
- A small mixture of anesthetic (such as lidocaine)
and anti-inflammatory medication (cortisone) is then
slowly injected into the joint.
The injection itself only takes a few minutes, but the
entire procedure usually takes between thirty and sixty
minutes. After the procedure, the patient typically remains
resting on the table for twenty to thirty minutes, and then
is asked to move the area of usual discomfort to try to
provoke the usual pain.
Patients may or may not obtain pain relief in the first
few hours after the injection, depending upon whether or not
the joints that were injected are the main source of the
patientís pain. On occasion, the patient may feel numb or
experience a slightly weak or odd feeling in the upper back
for a few hours after the injection. On the day of the
injection, patients are advised to avoid driving and avoid
doing any strenuous activities.
The patient should record the levels of pain relief
during the next week in a pain diary. Tracking the level of
pain is helpful to clearly inform the treating physician of
the injection results and in planning future tests and/or
treatment, as needed.