A precise, image-guided injection directly into a small joint of the spine — used to quiet localized back or neck pain and to help identify where it's coming from.
The facet joints — also called zygapophyseal joints — are small paired joints at the back of each level of your spine. They guide and limit motion as you bend, twist, and extend. Like any joint, they can become arthritic, inflamed, or irritated after injury, and when they are, they tend to produce a dull, achy pain centered close to the spine that gets worse with extending or rotating your back or neck.
A facet joint injection is an intra-articular injection — meaning it goes directly into the joint itself — of a small amount of local anesthetic combined with a corticosteroid. It is performed under fluoroscopy (live X-ray) so we can see exactly where the needle is and confirm correct placement with a small amount of contrast dye before the medication goes in.
Facet injections are most useful when the history and exam point toward facet-mediated pain and conservative care hasn't been enough. Typical indications include:
A facet injection is generally not the right choice when the dominant symptom is radiating pain down a leg or arm (which usually points to a nerve root, not a facet joint), when there is an active infection at the site, or when a bleeding disorder or anticoagulation has not been carefully managed. Pregnancy is a contraindication to fluoroscopy.
One important nuance: most spine interventionalists now use a medial branch block — not an intra-articular facet injection — as the gold-standard diagnostic test for facet pain, because the medial branch nerve is the eventual target if radiofrequency ablation (RFA) is needed. Intra-articular facet injections remain valuable when there's suspected synovitis or a facet cyst, or when a longer-acting therapeutic steroid effect is the goal. We'll be clear with you about which test is the right one for your situation, and why.
You lie face down on a fluoroscopy table. The skin over the target levels is cleaned with antiseptic and a sterile drape is placed.
A small amount of local anesthetic is used to numb the skin and tissue down to the joint. Most patients describe a brief sting and then pressure.
Under live fluoroscopy, a thin needle is guided into the joint. A small amount of contrast confirms placement, then anesthetic and steroid are delivered.
You rest for 15–20 minutes while we make sure you feel well. Total visit time is usually about 30 minutes.
Most patients walk out the same day. Mild soreness at the injection site is common for one to two days; ice and acetaminophen are typically enough. Most people return to normal activity the next day. The anesthetic portion of the injection can give you several hours of immediate relief — we'll often ask you to keep a simple pain diary over the next few days, because that early window is diagnostically useful. The steroid takes effect more gradually, usually over three to seven days, and lasting benefit (when it occurs) builds over the next few weeks.
Facet injections are generally very safe. The most common side effect is a temporary pain flare for a day or two as the local anesthetic wears off and before the steroid takes hold. Other risks include bruising or bleeding, infection (rare with sterile technique), and steroid-related effects such as a short-term rise in blood sugar in diabetics, facial flushing, or a few nights of disrupted sleep. Serious complications — significant nerve injury or spinal infection — are very uncommon.
KeyTone Medical is out of network with all commercial health insurance plans, so this procedure is self-pay, with the cost discussed before anything is scheduled. Many plans reimburse part of the cost of medically necessary care performed out of network — on request we provide a superbill, an itemized and coded receipt, for you to submit to your insurer under your plan's guidelines.
A medial branch block numbs the tiny nerve that carries pain signals away from a facet joint, without entering the joint itself. It's primarily a diagnostic test — and a positive result tells us radiofrequency ablation is likely to help. A facet joint injection goes into the joint and includes a steroid, which can offer some patients longer-acting relief. Each has its place; we'll explain why we're recommending one over the other.
It varies. Some patients get several months of meaningful relief; others get a few weeks; some get little benefit at all. When a facet injection helps and the relief wears off, that's usually our cue to discuss a medial branch block followed by radiofrequency ablation, which can provide longer-lasting results.
No. The injection reduces inflammation and pain — it doesn't reverse the underlying arthritis. The goal is to quiet the joint enough that you can stay active, do your physical therapy, and live more comfortably. Honest expectations help us plan the next step if one is needed.
The local anesthetic gives quick but brief relief. The steroid is an anti-inflammatory that takes a few days to start working and can extend the benefit for weeks or longer. If you have specific concerns about steroids — for example, if you're diabetic or have had side effects before — let us know and we'll adjust the dose or the plan.
Yes, but we don't repeat them indefinitely. Most practices limit facet steroid injections to roughly three per joint per year. If you're needing repeat injections to function, that's a strong signal we should be talking about medial branch blocks and radiofrequency ablation for longer-term control.
Authoritative references on this topic, for patients who want to read further. These are educational resources, not medical advice.
Educational information only. This page describes facet joint injections in general terms. Whether one is appropriate for you depends on your history, exam, imaging, and treatment goals. The risks, benefits, alternatives, and expected results will be discussed in detail at your visit.
