Facet Joint Injection

What It Is

The facet joints are pairs of small joints at the back of the spine that link each vertebra to the next. Like any joint, they have a capsule, a thin layer of cartilage, and a small amount of fluid — and like any joint, they can become arthritic, inflamed, and painful. A facet joint injection places a small amount of corticosteroid and numbing medicine directly into one or more of these joints under live X-ray (fluoroscopy) guidance.

Facet injections are used both diagnostically (does relief from the numbing medicine confirm the facet as the pain source?) and therapeutically (the steroid quiets inflammation in the joint for weeks to months).

How It Works

The corticosteroid is a strong anti-inflammatory. Placed inside the joint capsule, it reduces the inflammation that’s producing pain. The local anesthetic gives short-term relief and provides diagnostic information — if the joint is the source of pain, you should feel substantially better for the duration the numbing medicine works.

For facet pain that’s confirmed but doesn’t respond durably to intra-articular steroid, the next step is often a medial branch nerve block followed by radiofrequency ablation, which targets the nerves carrying pain from the joint instead of the joint itself.

When It’s Used

A facet injection is typically considered when:

• Back or neck pain is centered on the midline rather than radiating, worse with extension or twisting, and clinically suggests the facet joints as the source
• Physical therapy, NSAIDs, and activity modification haven’t settled the pain after a reasonable trial
• The diagnosis needs confirmation before considering the longer-acting medial branch block / radiofrequency ablation pathway

What to Expect

• The procedure takes about 15 to 30 minutes in a fluoroscopy suite at the pain management office or surgery center
• You lie face-down; the skin is cleaned and numbed with local anesthetic
• The interventional pain physician advances a small needle into the joint under live X-ray guidance, confirms position with contrast dye, then injects the steroid and numbing medicine
• Most patients drive themselves home unless sedation was used
• Diagnostic benefit (from the numbing medicine) is felt within the first hour; the therapeutic anti-inflammatory effect from the steroid takes a few days and lasts weeks to months

Risks and Limitations

• Temporary effect. A facet injection calms inflammation; it doesn’t cure the underlying arthritis.
• Steroid flare. A small group of patients gets a brief increase in pain in the first 24 to 48 hours.
• Blood sugar. If you have diabetes, expect a short rise in blood sugar after the shot.
• Infection. Very rare with sterile technique.
• Bleeding / bruising. More relevant if you take blood thinners.
• Imperfect specificity. A small amount of medicine can leak outside the joint, which can blur the diagnostic picture.

Why OSI Doesn’t Do This In-House

OSI does not perform facet joint injections in-house. They’re an interventional pain management procedure that needs live fluoroscopy and dedicated procedural training outside the OSI orthopedic scope. Patients who would benefit from a facet injection are referred to a trusted pain management physician we work with, with the relevant clinical exam findings and imaging sent ahead.

OSI continues to manage the conservative side — physical therapy oversight, medications, bracing, and follow-up — so the injection is part of a larger non-operative plan, not a one-off.

Next Steps

If you think you might be a candidate — or you just want a generalist read on whether this procedure is the right next step — schedule a spine evaluation at OSI or call (830) 625-0009. We will examine you, review imaging you bring with you, and either start a non-operative plan or coordinate the referral to a trusted pain management partner.