When are Facet Injections Appropriate and Effective?

Neck and low back pain are some of the most common complaints among adults, often interfering with mobility, sleep, and quality of life. When back or neck pain persists despite rest, medications, or physical therapy, targeted treatments may be necessary. One proven option is the facet injection, also known as a Z-joint injection. These minimally invasive procedures can provide both diagnostic clarity and meaningful pain relief.
 

Understanding Facet (Z-Joint) Pain

The facet joints (sometimes referred to as zygapophyseal (Z) joints) are small joints located posteriorly between the vertebrae in the spine. They provide stability and guide motion. Due to trauma or repetitive stress, these joints can become inflamed, leading to localized pain in the neck or back that may radiate into the shoulders, buttocks, or thighs. Facet joint pain can mimic other spinal conditions, which is why precise diagnosis is key to effective treatment.
 

What Is a Facet Injection?

A facet injection involves delivering a small amount of anesthetic and anti-inflammatory medication directly into or near the affected facet joint. Guided by advanced imaging techniques, such as fluoroscopy (X-ray guidance), the injection is both safe and highly targeted.
 

There are two primary purposes for this procedure:
 

•          Diagnostic: If pain relief follows the injection, it can suggest that the facet joint is the source of discomfort.

•          Therapeutic: The steroid medication reduces inflammation within the joint, which can lead to lasting pain relief and improved mobility.
 

Effectiveness of Facet Injections for Chronic Spine Pain

Medial branch blocks and radiofrequency ablation have become the standard approach to treat facet arthropathy, but there are key instances when an intraarticular facet joint injections may be appropriate:
 

•          Acute trauma without chronic signs of degeneration: Whiplash type events can manifest in irritation to the facet joints typically amenable to joint injection, despite relatively normal imaging findings

•          Identified inflammation: Due to a variety of mechanisms, joints may become visibly inflamed or “swollen” on an MRI or SPECT CT, which could make a patient a better candidate for intra-articular injection

•          Biomechanical considerations: In instances of spondylolisthesis, particularly when associated with spinal instability, joint injection may be the intervention of choice as radiofrequency ablation yields collateral damage to the multifidus which may precipitate or worsen spinal instability.

•          Facet synovial cysts: When a facet joint becomes so inflamed that the capsule surrounding the joint can no longer contain the inflammatory fluid, it may create an outpouching called a facet synovial cyst. The typical capacity of the joint is about 1mL. When the cyst forms anteriorly, it may cause compression on a nerve root and cause sciatica-type pain. This cyst can be ruptured or aspirated through a needle placed in the joint, sometimes preventing patients from requiring surgery.
 

For many patients, facet injections become an important part of a broader pain management plan that may include physical therapy, lifestyle changes, or additional interventional treatments. There are a number of factors to consider when deciding the appropriate pathway to treat facet arthropathy.
 

Discover if Facet Injections Are Right for You

Facet Arthropathy can be debilitating, but it does not have to define your life. Facet (Z-joint) injections offer both diagnostic insights and meaningful pain relief, helping patients restore function and comfort without the need for invasive surgery.
 

If you are struggling with persistent neck or back pain, schedule a consultation with Jacob T. Rohrs, M.D. to determine whether facet injections may be the right solution for you. Visit our office in Scottsdale, Arizona, or call (808) 645-4080 to book an appointment today.