Facet Joint Injections and Medial Branch Procedures for Spine Pain

Understanding the Facet Joints

Facet joints are small joints at the back of your spine that connect each vertebra. They allow for smooth motion while providing spinal stability. Over time, these joints can become irritated or arthritic, leading to chronic neck or back pain.

Common signs of facet joint pain include:

  • Pain that worsens with spinal extension or twisting

  • Localized pain in the neck or lower back

  • Referred pain into the shoulders or buttocks

Spinal anatomy showing the location of facet joints in the lumbar spine

Spinal anatomy showing the location of facet joints in the lumbar spine

When Are Facet Joint Procedures Recommended?

Facet joint procedures are typically recommended when conservative measures such as medications, physical therapy, or chiropractic care do not provide long-term relief.

These procedures help both diagnose and treat facet-related spinal pain.

1. Corticosteroid Facet Joint Injections

Facet injections deliver a mixture of corticosteroid and anesthetic medication directly into the inflamed facet joint.

Why it’s done:

  • Reduce joint inflammation

  • Relieve localized spinal pain

  • Determine if the joint is the true source of symptoms

What to expect:

  • Procedure done under fluoroscopy (X-ray guidance)

  • Performed using a thin needle

  • Results may take 2–5 days to appear

  • Pain relief can last from weeks to several months

2. Medial Branch Blocks

When facet injections offer temporary relief, medial branch blocks are the next diagnostic step.

These nerves (medial branch nerves) transmit pain signals from the facet joints to the brain.

Purpose:

  • Confirm that pain is facet-related

  • Predict success of future radiofrequency ablation

Details:

  • Local anesthetic is injected near the nerve

  • Relief is temporary (lasting a few hours)

  • If the patient experiences significant pain relief on two separate injections, they may be considered a candidate for ablation

3. Radiofrequency Ablation (RFA)

Radiofrequency ablation uses heat to disrupt the function of the medial branch nerves, stopping them from sending pain signals.

Benefits:

  • Pain relief can last 6–12 months

  • Minimally invasive and outpatient-based

  • May significantly reduce or eliminate the need for medications

What happens:

  • A special needle is used to deliver radiofrequency energy

  • Fluoroscopy ensures accurate placement

  • Local anesthetic and sedation may be used for comfort

  • x-ray image of a cervical facet joint injection

    Cervical Facet Joint Injection

  • x-ray image of a lumbar facet joint injection

    Lumbar Facet Joint Injection

  • Diagram of radiofrequency ablation targeting medial branch nerves

    Radiofrequency Ablation Procedure

Risks and Side Effects

Facet joint procedures are considered low-risk and are performed under image guidance for safety. However, as with any procedure, risks exist.

Common risks include:

  • Mild soreness at the injection site

  • Temporary flare-up of symptoms

  • Bruising or localized swelling

Rare but potential risks:

  • Infection

  • Bleeding

  • Nerve injury

  • Allergic reaction to medications

How to Prepare for Your Procedure

Please inform Dr. Sobel if you:

  • Have a bleeding disorder
  • Are taking medications or supplements that affect blood clotting, such as:
    • Aspirin
    • Warfarin, clopidogrel, ticlopidine
    • Heparin or enoxaparin
    • NSAIDs (e.g., ibuprofen, naproxen, meloxicam, diclofenac, etc.)

Most NSAIDs should be stopped at least 3 days prior to your procedure. Other medications—especially blood thinners—should be discussed with your primary care physician or cardiologist to determine how and when to safely pause them.

Click here to see a sample list of medications that may need to be stopped before your procedure »

Please also inform us if you’ve had any of the following within the past 4 weeks:

  • Hospitalization
  • Fever or illness
  • Antibiotic treatment

You should be healthy on the day of your procedure.

If You Have Diabetes

Monitor your blood sugar closely on the day of your procedure and for 2–3 weeks afterward if steroids are used, as they may cause temporary increases in glucose levels.

If You Will Be Sedated

If conscious sedation (twilight) is planned:

  • Do not eat solid food for 4–6 hours before the procedure
  • Do not drink liquids for 4 hours before the procedure
  • Only small sips of water or clear liquids are allowed up to 2 hours prior if needed to take your medications

Detailed fasting and medication instructions will be provided at your appointment with Dr. Jerry Sobel.

Non-Surgical Pain Relief at Sobel Spine and Sports

At Sobel Spine and Sports, Dr. Jerry Sobel offers image-guided, minimally invasive treatments for facet joint pain using state-of-the-art equipment and precision techniques.

We prioritize conservative, evidence-based care tailored to each patient’s diagnosis and lifestyle goals.

Frequently Asked Questions

How do I know if my pain is from the facet joints?
Facet joint pain is typically localized and worsens with spinal extension or rotation. Diagnostic injections can confirm if the joint is the true pain source.
Will the injection cure my condition?
No, injections treat the inflammation and help manage symptoms. They do not reverse arthritis or joint degeneration.
How long does the radiofrequency ablation last?
Most patients experience pain relief lasting 6 to 12 months, though some report relief for longer. The procedure can be safely repeated if pain returns.
What should I expect after the procedure?
You may experience some soreness for a few days. Ice, rest, and over-the-counter pain medication are usually sufficient for post-procedure care.
Is sedation necessary?
These procedures are typically done with local anesthetic. However, light sedation can be used depending on patient comfort and medical history.

Call to Action

📞 Phone: 602-385-4160

📍 Location: Phoenix, AZ

🗓️ Take the next step toward relief:
Schedule your appointment with Dr. Jerry Sobel today »