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Facet Joint Injections — Cervical / Thoracic / Lumbar Spine

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The facet (or zygapophyseal) joints are paired synovial joints linking vertebrae at all levels of the spine (cervical [C], thoracic [T], lumbar [L]). They help guide and limit spinal movement and share load-bearing responsibilities. ncbi.nlm.nih.gov+1

When these joints become inflamed, arthritic, or stressed, they can generate axial spine pain (neck, mid-back, or low back), sometimes extending into adjacent areas. ncbi.nlm.nih.gov+1

A facet joint injection involves placing medication (typically a local anesthetic plus steroid) directly into, or adjacent to, these joints under image guidance, with the aims of both diagnosing and treating facet‐mediated spinal pain.

Symptoms and Diagnosis of sacroiliac joint disorder

Common Symptoms

Persistent neck pain (if cervical facet joints), mid-back ache (thoracic), or low back pain (lumbar) that is worsened by extension, side-bending, or rotation.
Pain that is more local/axial rather than shooting far into arms or legs (in lumbar cases, pain rarely goes below the knee) – this helps differentiate from disc/radicular pain.
Stiffness in the morning or when getting up after sitting, increased pain with prolonged standing or backward bending.
Pain relief is often less likely with walking/radiculopathy-type features (if leg involvement is prominent, other sources may be involved).
Sometimes imaging (MRI/CT) may show facet degeneration or joint hypertrophy — but imaging alone is not definitive, as many degenerated facet joints are asymptomatic.

Causes of Facet Joint Pain

Degenerative arthritis of the facet joints (wear & tear) is the most common cause.
Segmental instability (micro-motion of vertebrae) that stresses the joint capsules.
Trauma or repetitive extension/rotation stress (especially in cervical or lumbar spine).
Inflammatory changes: synovitis, capsular distension, impingement of joint structures.
Adjacent segment degeneration after spinal fusion; or facet joint synovial cyst formation.

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Face Joint injection Treatments for the Cervical, Thoracic & Lumbar Spine

Conservative management: Physical therapy focused on core stabilization, posture correction, extension exercises, side-bending/rotation control; activity modification; weight management and anti-inflammatory medications.
Medications: NSAIDs, muscle relaxants, pain modulation medications as appropriate.

Facet joint injections (Therapeutic/Diagnostic):
Under fluoroscopic or CT guidance, a small needle is placed into or near the facet joint and injectate (local anesthetic + steroid) is delivered.
The injection may serve to confirm that the facet joint is the pain source (diagnostic) and to reduce local inflammation/pain (therapeutic).
Efficacy: Studies show variable results — for lumbar facet injections, about half of patients experience significant pain relief in the short- to medium-term and a smaller number benefit long-term.
Evidence for cervical and thoracic facet injections is weaker compared to lumbar.

Medial branch nerve blocks: Sometimes performed to further pinpoint facet joint pain and guide intervention strategies like radiofrequency ablation.

Lifestyle & rehabilitative adjuncts: Core strengthening, flexibility work, ergonomics, postural correction, weight control, smoking cessation (where applicable).

If facet joint pain is confirmed and persistent, or if there is significant joint degeneration/instability, advanced interventions may include medial branch radiofrequency ablation (to denervate the facet joint), or in select cases facet joint replacement or stabilization surgery (less common).
The injection procedure itself is minimally invasive and outpatient; surgery is reserved when conservative and interventional treatments fail.