Facet joint injection

Facet (zygapophysealjoint injections are one of the most frequently performed spinal interventional procedures, as both treatment for and diagnosis of radicular pain syndrome and facet syndrome. It can be performed under fluoroscopic, or CT image guidance and cervical, thoracic or most commonly lumbar facet joints can be injected. Often the procedure is performed at multiple levels or bilaterally. 

  • facet syndrome: both diagnostic (i.e. relief of pain after injection of local anesthetic) and therapeutic
  • chronic low back or neck pain
  • low back pain (+/- sciatica) with normal imaging findings
  • post-laminectomy syndrome

There are no specific absolute contraindications, but relative contraindications include 2:

  • systemic infection or cutaneous infection over the injection site
  • coagulopathy
  • contrast reaction or other medication allergies
  • pregnancy
  • history of presenting complaint: type, nature, severity, duration and location of back pain
  • relevant medical and surgical history
  • review relevant laboratory results
  • review prior imaging
  • counseling patient about onset, length and likelihood of pain relief
  • gaining informed consent
  • patient is typically in a prone position
  • sterile dressing pack; sterile gown and gloves
  • 10 mL syringe, hypodermic needle and local anesthetic (e.g. lignocaine) for subcutaneous infiltration
  • long spinal needle (typically 22 G), 3 mL syringe, steroid (e.g. betamethasone), long-acting local anesthetic (e.g. ropivacaine, bupivacaine) for intra-articular injection
  • contrast (not always necessary as periarticular injections seem to have the same result as intra-articular injections)
  • dressing

The typical capacity of a facet joint is approximately 2 mL. Injection of large volumes can cause capsular disruption, and discharge of the anesthetic and steroid mixture into adjacent soft tissues, including the epidural space.

  • content required
  • time out
  • targeted planning scan and skin marking
  • sterile preparation and drape
  • subcutaneous infiltration of local anesthetic
  • advancement of the spinal needle under CT guidance to the targeted facet joint
  • optional intra-articular injection of a small amount of contrast to assess intra-articular position
  • injection of 1 mL steroid and 1 mL long-acting local anesthetic
Post-procedure care
  • pain score assessed immediately and 15-20 minutes post procedure
  • observe for 20-30 minutes for any immediate complications

Complications are rare 2, 3:

Although early studies reported reasonable long term relief of symptoms (20-54%), more recent studies have suggested that steroid injection "is of little value". However, short term relief is common (59-94%) and therefore it remains a useful procedure, especially to confirm the diagnosis.

Interventional procedures
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Article information

rID: 1316
System: Spine
Tag: cases
Synonyms or Alternate Spellings:
  • Facet joint injections
  • Zygapophyseal joint injections
  • Z joint injections

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