Overview
The facet joints (also called zygapophyseal joints) are the small paired joints at the back of each spinal level that provide stability and guide motion. Facet joint arthritis and inflammation is one of the most common causes of axial (non-radiating) back and neck pain — estimated to account for 15–45% of chronic low back pain and up to 54% of chronic neck pain. Facet joint injections deliver local anesthetic and corticosteroid directly into the joint under fluoroscopic guidance, providing both diagnostic confirmation and therapeutic relief.
Recognizing Facet-Mediated Pain
Facet pain is typically described as a deep, achy pain localized to the back or neck — without the radiating quality of nerve root pain. It is often worsened by spinal extension (bending backwards), rotation, and prolonged standing. It does not follow a dermatomal pattern. In the lumbar spine, facet pain commonly refers into the buttock and thigh; in the cervical spine, it can refer into the shoulder and upper arm — sometimes mimicking radiculopathy.
The Role of Diagnostic Injection
Because facet joint degeneration appears on MRI in most adults over 40 (including asymptomatic individuals), imaging alone cannot confirm the facet joint as the pain source. A diagnostic facet joint injection or medial branch block — which provides significant temporary relief — is required to confirm the diagnosis. This diagnostic step is critical before proceeding to more definitive treatment such as radiofrequency ablation.
Treatment Progression
Therapeutic facet injections with corticosteroid can provide weeks to months of relief. For patients who respond consistently to injections but experience only temporary benefit, medial branch radiofrequency ablation — which denervates the facet joint by ablating the medial branch nerves that supply it — provides much longer-lasting relief, often 12–18 months or more.