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Facet Joint Block

facet block or facet joint block is a spinal injection of anesthetic and corticosteroid into one or more facet joints (Fig. 1).  The anesthetic provides temporary pain relief.  The corticosteroid is a powerful and long-lasting anti-inflammatory medication that helps to calm inflamed cervical (neck), thoracic (mid back), and lumbar (low back) nerves and reduce pain.

Facet joints are located at the back of your (posterior) spinal column.  Each vertebra has two facet joints that help to connect the vertebra above to the vertebra below.  A facet joint is similar to other joints in your body and can be affected by arthritis, infection, or other disorder.  Twisting and bending spinal injuries can also cause facet joint irritation or damage resulting in pain.

Tiny facet joint nerves can become irritated, inflamed and cause cervical (neck) and lumbar (low back) pain.  Facet-related pain does not shoot or radiate like sciatica and is not associated with weakness or numbness.  It is made worse by movement, poor posture, cold or damp weather, and sleep.

Facet block injections can be administered at a clinic, outpatient center, or hospital. Many physician specialists are qualified to perform injection procedures including anesthesiologists, radiologists, neurologists, physiatrists, and spine surgeons.

Potential Benefits

Facet joint blocks can be an important part of your diagnostic and treatment program. A facet joint block offers patients two potential benefits: 

  1. reduce inflammation and pain in a facet joint or joints
  2. provide diagnostic  information about the cause, location and/or pain source

While a facet block may quickly reduce pain, relief is not permanent and a repeat block may be recommended depending on the outcome of the first.  Facet blocks are usually performed to help manage chronic neck or back pain. 

Because a facet joint block may include a steroid (corticosteroid), the number of injections is limited to help prevent and minimize steroid-related side effects such as loss of bone density.

Possible Complications

A facet block, like other medical procedures, may present risks.  Complications include increased pain, bleeding, infection, headache, injury to nerve tissue, and/or allergic reaction to medication.

Some patients should not undergo a facet block.  Restrictions usually include:

  • Allergy to drugs to be injected
  • Bleeding problems
  • Infection
  • Kidney disease
  • Pregnant or breast-feeding
  • Severe spinal abnormality

Patient Preparation: Current Medication

  • Tell your doctor about all prescription medication you take, including over-the-counter types. Some types of drugs, such as blood thinners, must be discontinued before your procedure. Below is a short list of common instructions. Your doctor will provide a more specific list for you.
  • Stop blood-thinning medication 2-days prior to the test
  • Do not take any aspirin products 5-days prior to the test
  • Stop anti-inflammatory medication 5-days prior to the test
  • Stop pain medication 8-hours prior to the test
  • Do not eat or drink 6-hours prior to the test
  • Arrange for someone to drive you home
  • Your doctor may have you discontinue anti-inflammatory or pain medications before the procedure to more accurately determine the amount of pain relief you get from the injection. This is important for your diagnosis. 

Patient Preparation: At the Medical Facility

  • The medical staff reviews your history, condition, medications, allergies, and other pertinent information.
  • You change into a gown.
  • An IV (intravenous) line is started in your arm (or hand) and you may be given a medication to help you relax.

What to Expect During the Procedure

Overview: Facet block procedures are performed using fluoroscopy (real time image guidance) to guide needle placement.  Fluoroscopy allows the doctor to see the procedure, similar to real time x-ray.  When the needle tip is positioned at the target area, an anesthetic and corticosteroid medication is injected.

  • You may be positioned face down on the x-ray table.  Pillows and other cushions are placed about you to help keep you comfortable. 
  • The skin around the injection site is cleaned and prepared.  A local anesthetic numbs the skin around the injection site. Although a local anesthetic slightly stings, it helps to make the block more comfortable.
  • The doctor inserts the needle using image-guidance (fluoroscopy) for positioning.  When the needle is properly positioned, the medication is injected into the facet joint.
  • After the injection, the needle is removed and a small bandage is applied to cover the injection site.
  • The procedure takes about 15-30 minutes, unless additional level(s) are injected.

After the Procedure

  • You are transported into the recovery area where the medical staff continues to monitor your vital signs. 
  • You may be discharged home 30- to 60-minutes after the procedure with written instructions that may include:
      - Starting or resuming medication and activity
      - Other restrictions the day of the procedure
      - Starting or resuming physical therapy
  • The area around the injection site may feel feel numb.  Tenderness around the site may be experienced for a couple of days after the injection. 
  • Keep a pain journal.  It is important that you keep track of the amount of pain relief you received as well as how long the pain relief lasted. This will help you and your doctor to measure the injection's effectiveness.
  • Steroids may cause side effects that include blurred vision, frequent urination, increased thirst and change in blood sugar levels, especially in diabetic patients.  If these side effects become bothersome or worsen, please notify the doctor.
  • If fever, chills, increased pain, weakness or loss of bowel/bladder function occurs, seek immediate medical attention.
  • Please follow-up with your doctor.