Adam Sewell MD


Facet injections are a minimally invasive, non-surgical, treatment for many different causes of neck and back pain. They works by reducing the inflammation, and associated pain, in the facet joints of the spine.

The syndromes most commonly requiring Facet Injections include:

  • Spinal Stenosis
  • Herniated Disk
  • Sciatica
  • Spondylolysis


The facet joint of the spine is a moveable connection. It connects one vertebra (bone of the spine) to another. This injection uses a long-lasting steroid and an anesthetic (lidocaine, bupivacaine). The steroid reduces the inflammation, and subsequent irritation, and the anesthetic numbs the pain. The combination spreads to other levels and areas of the spine, reducing inflammation and pain. The entire procedure usually takes less than 15 minutes.

Facet Injections and Epidural Steroid Injections (ESI) are very similar, but they differ in where the medication is located. In an ESI, the medication is injected into the epidural space. In the facet injections, it is injected directly into the joint.


Facet joint injections are most successful in the rapid relief of symptoms. Pain management occurs quickly, allowing patients to experience enough relief to become active again. They are able to resume their normal daily activities faster than with oral medications and physical therapy.

Facet injections can be used as a diagnostic tool, as well, to see if the pain is actually coming from the facet joints. Sometimes, it is radiating from other locations. If your pain disappears with the injection, then it is originating from the joint. Therapeutic lumbar facet joint nerve blocks with local anesthetic, with or without steroids, may be effective in the treatment of chronic low back pain of facet joint origin. (Manchikanti 2007). However, if your pain is unresponsive, then your physician will look for another source for your pain.

The American Society of Interventional Pain Physicians affirm the accuracy of facet joint nerve blocks as highly accurate in the diagnosis of lumbar and cervical facet joint pain (Boswell 2007).


Facet injections offer only a very minimal amount of risks, and they are considered an appropriate non-surgical treatment for many patients who suffer from back pain. The risks associated with the procedure are – misplacement of the needle, advancing the needle too deeply or positioning it incorrectly. This can, potentially, cause nerve damage, bleeding, infection, and a headache following the injection.

As with any medication or treatment, there are always risks and potential side effects. Some additional minor risks with facet injections can be directly caused by the medication given. Some of these side effects are much higher in a person taking oral corticosteroids. Potential side effects of corticosteroids are elevated blood sugars, weight gain, arthritis, stomach ulcers, and a lowered immune system. All patients should be thoroughly assessed before by their physician before receiving a facet injection.


Lumbosacral injections have increased dramatically in the last decade, because they have proven very successful in the treatment of back pain.

Recent research reveals that 53% of patients with back pain, who received facet injections for eight weeks of treatment, reported improvement of their pain. By 6 months of treatment, over 68% reported the same (Anand 2007). The duration of pain relief varies from person to person, but if the first facet injection provides only minimal relief, the procedure can be repeated up to three times in one year.


  1. Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a randomized, double-blind controlled trial: clinical trial NCT00355914. Manchikanti L, Manchikanti KN, Manchukonda R, Cash KA, Damron KS, Pampati V, McManus CD. Pain Physician. 2007 May;10(3):425-40 PMID: 17525777
  2. Increases in lumbosacral injections in the Medicare population: 1994 to 2001 Friedly J, Chan L, Deyo R. Spine. 2007 Jul 15;32(16):1754-60 PMID: 17632396
  3. Patients’ response to facet joint injection. Anand S, Butt MS. Acta Orthop Belg. 2007 Apr;73(2):230-3 PMID: 17515236
  4. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Boswell MV,Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB,Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L; American Society of Interventional Pain Physicians. Pain Physician. 2007 Jan;10(1):7-111 PMID: 17256025

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