CT-guided spinal injection
Facet joint injection
A facet joint injection is an image-guided procedure in which medication is placed into or around one of the small joints at the back of the spine. It may be used to help manage neck or back pain, or to help determine whether a facet joint is contributing to your symptoms.
Dr Ryan McConnell performs CT-guided facet joint injections and related medial branch procedures in Sydney.
Spinal anatomy
What are the facet joints?
The facet joints are paired joints at the back of each spinal segment. They guide and limit movement of the spine and, like other joints, can be affected by wear-related (degenerative) changes.
In some people, the facet joints may contribute to neck or back pain. Facet-related pain is often felt in the neck or lower back and may spread into the shoulders, buttocks or upper thighs. However, these symptoms can also come from other structures, and imaging changes in the facet joints are common in people without pain.
Assessment
Who may be considered for a facet joint injection?
A facet joint injection may be considered when:
- neck or back pain has persisted despite conservative treatment such as physiotherapy, exercise and pain relief
- the pattern of pain and examination suggest the facet joints may be involved
- CT or MRI has been reviewed and other causes requiring different treatment have been considered
The decision is based on your symptoms, imaging and previous treatment rather than imaging findings alone.
Two related procedures
Facet joint injection or medial branch block?
Two related procedures can be used for facet-related pain:
Facet joint injection
Local anaesthetic, often with a corticosteroid, is placed into or immediately around the joint.
Medial branch block
Local anaesthetic is placed beside the small medial branch nerves that carry pain signals from the facet joint.
A medial branch block is mainly a diagnostic test. If it provides clear short-term relief, radiofrequency treatment of the medial branch nerves may be considered.
The procedure
How is a CT-guided facet joint injection performed?
- You lie on the CT table, usually face down. A small number of CT images are taken to plan the needle path.
- The skin is cleaned and local anaesthetic is used to numb the area.
- A fine needle is positioned at the target joint using CT guidance, and its position is checked before medication is injected.
- The needle is removed and a small dressing applied. The procedure usually takes around 15–30 minutes.
Most facet joint injections are performed with local anaesthetic alone.
Suggested image
CT image taken during the procedure, showing the needle tip positioned at a lumbar facet joint.
After your injection
What to expect after a facet joint injection
The local anaesthetic can cause numbness or reduced pain for several hours. If a corticosteroid is used, any effect may take a few days to develop.
For diagnostic procedures you may be asked to record your pain levels over the hours after the injection, as this helps guide further management.
You will usually need someone to drive you home. Most people resume light activities the next day, guided by the instructions provided.
When to seek medical advice
Contact your doctor or seek urgent medical attention if you develop fever, increasing redness, swelling, warmth or discharge at the injection site, severe or worsening pain, or new weakness or numbness.
Risks & considerations
Side effects and risks
Facet joint injections are commonly performed, but all procedures carry some risk.
Blood-thinning medications may need to be reviewed before the procedure. Please let us know about all medications you take.
Potential side effects and risks include:
- temporary soreness at the injection site or a short-term increase in usual pain
- temporary numbness or weakness from local anaesthetic
- corticosteroid effects such as facial flushing, disturbed sleep or a temporary rise in blood glucose in people with diabetes
- infection or bleeding, which are uncommon
- rarely, nerve injury or allergic reaction
FAQs
Frequently asked questions about facet joint injections
What is a facet joint injection?
How successful are facet joint injections?
How long does the effect last?
Is a facet joint injection painful?
How much does a facet joint injection cost in Australia?
Can facet joint injections be repeated?
Facet joint injection
Discuss a facet joint injection with Dr Ryan McConnell
If you have ongoing neck or back pain and your doctor has suggested a facet joint injection, Dr McConnell can review your imaging and history to help determine the most appropriate procedure.