The spine is comprised of small, interconnected structures such as the vertebrae, disc, facet joints, nerves and spinal cord. Facet joints are small joints that connect the bones of the spine, called vertebrae. They come in pairs on each side of each vertebra and allow for movement such as bending and twisting. Like other joints in the body, facet joints can become painful due to wear and tear, leading to arthritis or degenerative changes, especially with age. Injuries that overstretch the joint capsule can cause sprains, and autoimmune conditions such as rheumatoid arthritis may lead to inflammation and joint damage.
Pain from facet joints is usually felt near the affected area such as in the neck, upper back, mid-back, or lower back. However, the pain can refer and spread to nearby areas like the head, shoulder, or buttocks. Stiffness, grinding sensations, and muscle spasms are also common symptoms of arthritis in the facet joints.
Treatment for facet joint pain often begins with conservative options such as physical therapy, anti-inflammatory or pain medications, and home exercise programs. If these do not provide enough relief, injection therapy may be used. A facet joint injection is a minimally invasive procedure performed in an outpatient clinic under local anesthesia and fluoroscopic (live X-ray) guidance. There are many different options of injectable treatments for facet joint pain. The most common injection is a mixture of steroid medication and local anesthetics – these reduce inflammation and provide temporary pain relief, often lasting three to four months. Another option is a nerve block, which numbs the small nerves that carry pain signals from the joint. If successful, this is followed by radiofrequency ablation (RFA) to provide longer-lasting relief by stopping those nerves from transmitting pain. These 2 injections provide temporary relief and do not improve the degeneration in the facet joint. Newer treatments, such as orthobiologic injections, may help improve arthritis and promote longer-term healing. These include cells that can assist in tissue proliferation, modulating inflammation and decreasign pain.
Facet joint injections are generally safe, but possible risks include mild soreness at the injection site, medication reactions, bleeding (especially for those on blood thinners), and rare infections.
