Facet Joint Injections
Facet Joint Injections for Chronic Neck Pain and Lower Back Pain in New Jersey.
Facet joint injections are a targeted, minimally invasive treatment for pain that originates from the small joints that run along the back of the spine. These joints, called facet joints or zygapophyseal joints, are present at every level of the cervical, thoracic, and lumbar spine. They connect the vertebrae to each other, guide the spine’s range of motion, and bear a portion of the spine’s load with every movement. Like any joint in the body, facet joints are subject to the effects of aging, degeneration, and arthritis — and when they become inflamed or degenerated, they can produce significant, chronic spine pain.
A facet joint injection places a combination of local anesthetic and anti-inflammatory steroid medication directly inside the facet joint capsule under fluoroscopic imaging guidance. The medication treats the inflammation within the joint itself, reducing pain at its source and providing meaningful relief for patients whose back or neck pain originates from facet joint disease.
Facet joint injections are distinct from medial branch blocks, which are a related but different procedure that targets the nerve supply of the facet joint rather than the joint itself. Both procedures treat facet-mediated pain through different mechanisms. Understanding which approach is most appropriate for a given patient is part of the clinical evaluation Rishi N. Sheth, MD conducts before recommending any injection.
Dr. Sheth performs all facet joint injections at Spine Care New Jersey under continuous fluoroscopic imaging guidance. Every injection is preceded by a thorough clinical evaluation and imaging review to confirm that facet joint disease is a likely source of the patient’s pain, and every injection is performed with real-time imaging to ensure accurate intra-articular placement before any medication is delivered.
Recognizing Whether Your Back or Neck Pain Is Coming From the Facet Joints.
Facet joint pain is one of the most commonly encountered and most frequently under-diagnosed sources of chronic spine pain. Part of the reason it is underdiagnosed is that its symptoms overlap significantly with other causes of back and neck pain, and standard MRI findings of facet arthritis do not always correlate clearly with which pain generator is dominant in a given patient. Understanding the typical pattern of facet joint pain helps identify which patients are most likely to benefit from facet joint injections.
Lumbar facet joint pain characteristically produces lower back pain that is axial in nature, meaning it stays primarily in the lower back and may refer into the buttocks or upper thighs, but does not typically radiate below the knee the way disc-related nerve root pain does. The pain is usually worse with extension of the lower back, meaning bending backward or standing upright for prolonged periods, and with rotation. It tends to improve with flexion, which is why many patients instinctively lean forward when standing or walking. Prolonged sitting may also aggravate the pain as the facet joints are compressed in certain seated positions.
Cervical facet joint pain produces neck pain that may radiate into the back of the skull, the shoulder, or the upper back, but typically does not travel down the arm in the distribution of a specific nerve root the way cervical radiculopathy does. The upper cervical facet joints, particularly C2-C3 and C3-C4, are a leading source of cervicogenic headaches — headaches that originate from the neck and present as pain at the base of the skull or across the back of the head. Patients with this pattern who have not responded to standard headache treatments often find that cervical facet joint injections provide significant relief.
Thoracic facet pain presents as mid-back pain, sometimes with a wrapping quality around the rib cage, that worsens with rotation and extension of the thoracic spine. It is less common than lumbar or cervical facet disease but responds well to thoracic facet injections when facet joints are confirmed as the pain source.
The first is older adults with osteoporosis. Osteoporotic compression fractures are the most common fractures in adults over 65, and they represent a major source of pain, disability, and loss of independence in the elderly population. Vertebroplasty and kyphoplasty provide these patients with rapid stabilization of the fractured vertebra and meaningful pain relief that allows them to return to activity, reduce their dependence on narcotic pain medications, and avoid the debilitating consequences of prolonged immobility including muscle deconditioning, blood clots, and pneumonia.
The second major population is patients with cancer-related vertebral fractures. When cancer spreads to the vertebrae and destroys the structural integrity of the bone, the resulting pathological fractures produce severe pain and can compromise the patient's ability to continue their cancer treatment. Vertebroplasty and kyphoplasty stabilize these fractures rapidly, often dramatically improving the patient's quality of life and allowing them to maintain the functional status necessary to continue with chemotherapy, radiation, or other systemic treatments.
Facet Joint Injections and Medial Branch Blocks Both Treat Facet Pain Here Is How They Differ.
Because facet joint injections and medial branch blocks both treat facet-mediated spine pain, patients and referring physicians sometimes use the terms interchangeably. They are related but distinct procedures, and understanding the difference helps patients understand why Dr. Sheth recommends one over the other for their specific situation.
Facet Joint Injection
A facet joint injection places medication directly inside the facet joint capsule. The needle enters the joint space itself, and the combination of local anesthetic and steroid is delivered into the intra-articular environment. This approach is most appropriate when the goal is primarily therapeutic, targeting the inflammation within the joint directly. It is particularly useful when the facet arthritis visible on imaging is clearly severe, when the pain pattern is consistent with intra-articular facet pathology, and when a direct therapeutic injection is the priority.
Medial Branch block
A medial branch block targets the medial branch nerve that carries pain signals from the facet joint, placing anesthetic alongside the nerve outside the joint rather than inside it. This approach is most appropriate when the diagnostic question is as important as the therapeutic one, because the response to the medial branch block serves as the confirmation of facet joint pain needed to proceed to radiofrequency ablation. Medial branch blocks are also used when intra-articular injection is technically more challenging due to severe joint space narrowing from advanced arthritis.
In practice, Rishi N. Sheth, MD selects between these approaches based on the patient’s specific clinical presentation, imaging findings, and the goals of treatment. For some patients, a facet joint injection is the right starting point. For others, medial branch blocks are more appropriate because confirming the diagnosis before committing to a longer course of treatment is the priority. In some cases, both are used as part of a comprehensive facet joint pain management plan.
What Happens Before, During, and After a Facet Joint Injection.
Before the Procedure
Every facet joint injection at Spine Care New Jersey is preceded by a thorough clinical evaluation that includes a review of the patient's imaging, identification of the facet levels most likely to be the pain source based on the distribution of symptoms and the degree of facet arthritis on MRI or CT, and a clear discussion of the procedure and what to expect from it. Patients are asked about blood thinning medications, which may need to be temporarily held. Fasting is generally not required and patients are asked to arrange for someone to drive them home after the procedure.
During the Procedure
Facet joint injections are performed with the patient lying face down on the fluoroscopy table. The skin over the injection area is cleaned and local anesthetic is applied to numb the superficial tissues before the procedure needle is advanced. Under continuous fluoroscopic guidance, Dr. Sheth carefully advances the needle toward the facet joint, using imaging in multiple projections to confirm that the needle tip is positioned accurately within the joint space before any medication is delivered.
A small amount of contrast dye is injected to confirm intra-articular needle placement. The distribution of the contrast within the joint capsule confirms that the medication will be delivered directly into the joint rather than into the surrounding tissue. Once placement is confirmed, the combination of local anesthetic and steroid is gently injected into the joint.
Most patients experience localized pressure during the procedure and brief discomfort as the needle enters the joint space, which is well tolerated. The procedure typically takes 20 to 30 minutes depending on the number of levels being treated.
After the Procedure
In the first few hours after a facet joint injection, patients often notice some reduction in their typical pain from the local anesthetic effect. This early effect fades over the course of the day as the anesthetic wears off. The therapeutic benefit of the steroid begins to develop over the following three to seven days and reaches its maximum effect at approximately two weeks.
Some patients experience a brief flare of their usual pain in the first 24 to 48 hours after the injection, which is a known response to the injection itself and resolves quickly. Applying ice to the injection site can help with localized soreness in the first day.
Patients are advised to avoid heavy lifting and strenuous physical activity on the day of the procedure and to resume normal activities gradually over the following day or two as comfort allows. Physical therapy, if prescribed alongside the injection, continues through the post-injection period and benefits from the pain relief the injection provides.
Facet Joint Injections Performed Within a Complete Spine Care Evaluation.
The effectiveness of a facet joint injection is determined as much by accurate patient selection and precise needle placement as by the medication itself. An injection that places steroid inside a joint that is not actually the pain source will not provide meaningful relief regardless of how technically well executed it is. And an injection that misses the intra-articular space due to inadequate imaging guidance or limited anatomical experience will not achieve the therapeutic benefit the procedure is capable of providing.
Rishi N. Sheth, MD performs facet joint injections within the context of a thorough clinical evaluation in which he has already reviewed the patient's imaging, conducted the physical examination, and developed a specific hypothesis about the role of facet joints in that patient's pain. The injection is performed to test and treat that hypothesis, and the response to the injection directly informs what comes next in the treatment plan.
His fellowship training in spine surgery and his background in neurosurgical anatomy provide a depth of understanding of spinal anatomy that benefits every fluoroscopic-guided procedure he performs. The accuracy of intra-articular facet injection, particularly at the cervical levels where the joint spaces are small and the surrounding structures are closely packed, reflects a level of anatomical familiarity that comes from years of focused spine training.
At Spine Care New Jersey, patients who receive facet joint injections are followed up by the same physician who performed the injection, reviewed their imaging, and will interpret the clinical response. This continuity of care means that the result of each injection is used to make the next treatment decision as accurately as possible, rather than being lost in a referral chain between different providers.
Common Questions About Vertebroplasty and Kyphoplasty at Spine Care New Jersey.
The most common side effects after a facet joint injection are temporary localized soreness at the injection site and a brief flare of the patient’s usual pain in the first 24 to 48 hours, which reflects the mechanical effect of the injection before the steroid takes effect. Applying ice to the area and resting for the remainder of the injection day manages these symptoms well for most patients. Rare but possible side effects include infection, bleeding, and a temporary rise in blood sugar in diabetic patients from the steroid component. Rishi N. Sheth, MD discusses all relevant side effects before every procedure.
Most patients notice meaningful pain relief beginning three to seven days after a facet joint injection, with maximum effect at approximately two weeks as the steroid reaches full anti-inflammatory activity. The duration of relief varies considerably between patients, ranging from several weeks to several months. Patients whose facet joint pain has a significant inflammatory component tend to experience longer-lasting relief than those with primarily mechanical or structural facet disease. If relief is meaningful but temporary, the injection can be repeated, and patients with confirmed facet joint pain may also be candidates for radiofrequency ablation of the medial branch nerves for longer-lasting relief.
Spine Care New Jersey in northern New Jersey is led by Rishi N. Sheth, MD, a board-certified spine neurosurgeon who performs fluoroscopic-guided facet joint injections for cervical, thoracic, and lumbar facet joint pain as part of a comprehensive non-surgical spine care program. Dr. Sheth personally evaluates every patient, performs the injection, and follows up on the response within the context of the complete treatment plan. New patients throughout northern New Jersey can book a consultation at spinecarenj.com.
Most physicians recommend no more than three facet joint injections per year per spinal region to limit cumulative steroid exposure. If a facet joint injection provides meaningful but temporary relief, it can be repeated at an interval of at least six to eight weeks. If repeated
injections consistently provide temporary but not lasting relief, radiofrequency ablation of the medial branch nerves is typically the next step, as it offers a longer-lasting solution for confirmed facet joint pain by interrupting the nerve supply to the joint rather than treating the joint inflammation directly.
Most PPO insurance plans cover facet joint injections when prescribed by a physician and documented as medically necessary for the treatment of facet-mediated spine pain. Spine Care New Jersey is an out-of-network practice, which means patients with PPO plans use their
out-of-network benefits to cover their care. Our team verifies your specific out-of-network benefits before your appointment so you know your estimated out-of-pocket cost in advance with no surprises. Patients with coverage questions are encouraged to contact the office directly before scheduling.