Facet Joint Injections

Before undergoing facet joint injections, you will typically have a consultation with your spinal surgeon or pain medicine consultant to discuss your medical history, symptoms, and any allergies or medications you are taking. This includes reviewing any blood tests or imaging studies, such as X-rays or MRI scans, to identify the affected joints.

It is also important to disclose any history of infections or skin conditions in the area around the injection site to minimise the risk of infection.

The doctor will also discuss the risks, benefits, and available treatment options, ensuring you have all the information you need to make an informed decision.

During the procedure, you will be positioned comfortably, often lying face down for injections in the lower back. The skin over the injection site is cleaned thoroughly with an antiseptic solution to reduce the risk of infection.

Using imaging guidance such as X-ray, the consultant will insert a small needle into the facet joint. You may feel some pressure or mild discomfort during needle insertion, but the local anaesthetic helps numb the area to minimise pain.

Once the needle is correctly positioned, the consultant injects the local anaesthetic and corticosteroid mixture. The entire procedure typically takes less than 30 minutes and is usually performed without sedation, allowing patients to remain awake and alert.

Following the injection, you will be monitored in a recovery area for a short period to observe any immediate reactions or side effects. It is common to experience temporary numbness or mild soreness at the injection site.

Pain relief from the local anaesthetic typically begins within a few hours but is temporary. The corticosteroid’s anti-inflammatory effects may take a few days to manifest, providing a longer-term reduction in facet joint pain and inflammation. Some patients may experience soreness or discomfort for a day or two, which can be managed with normal pain medications.

You should rest for the remainder of the day and avoid strenuous activities or heavy lifting for several days (or as advised by your doctor) to allow inflammation to settle and to maximise the benefits of the injection. It is important to keep the injection site clean and dry to prevent infection.

Risks and possible complications

Facet joint injections are generally considered safe when performed by an experienced clinician using imaging guidance. However, as with any medical procedure, there are potential risks and side effects.

Common and usually temporary effects

• Mild pain, soreness, or stiffness at the injection site
• Temporary increase in back pain for a day or two
• Temporary numbness or weakness in the affected area due to the local anaesthetic
• Facial flushing or a feeling of warmth following the steroid injection

Less common risks

• Infection at the injection site (rare)
• Bleeding or bruising, particularly in patients taking blood-thinning medications
• Allergic reaction to the local anaesthetic, steroid, or contrast dye (if used)
• Headache, especially if the injection is performed near the cervical spine

Rare complications

• Nerve irritation or injury
• Steroid-related side effects such as temporary elevation of blood sugar levels, especially in patients with diabetes
• Failure to achieve pain relief or only short-term benefit

Your doctor will take precautions to minimise these risks, including using sterile techniques, imaging guidance, and carefully reviewing your medical history and medications before the procedure. If you experience severe pain, increasing redness or swelling, fever, or new neurological symptoms after the injection, you should contact your doctor promptly.