Lumbar spine
Lumbar facet joint injection
The small joints located on either side of the spine, often involved in chronic back pain, are visible on ultrasound in most patients and can be treated with precision under direct needle guidance.
How it is performed
Facet joints are the small posterior joints that guide movement between one vertebra and the next. When they develop osteoarthritis, they generate low back pain that worsens with back extension and prolonged standing. Using ultrasound, the joint or its nerve branch (medial branch) is identified and reached with a thin needle, under direct visualisation and without radiation exposure; a small amount of anaesthetic and corticosteroid is then injected. This is an outpatient procedure.
Who it is for
- Chronic low back pain of suspected facet origin
- Pain that worsens with back extension or prolonged standing
- Diagnostic assessment before possible radiofrequency denervation
Recovery
You return home immediately and resume normal activity the same day. Relief from the anaesthetic is immediate; the effect of the corticosteroid develops over a few days.
Conditions treated in this area: chronic low back pain, disc herniation and sciatica, sacroiliac joint pain, muscle tension and pain (paraspinal, piriformis).
Scientific evidence
Reviews on the ultrasound-guided approach to the posterior spinal structures show accuracy comparable to fluoroscopic guidance at the lumbar level, without radiation exposure. Randomised studies confirm the benefit of facet block/injection in selected low back pain, and also define its role as a diagnostic test before radiofrequency treatment.
References on PubMed
- Ultrasound-guided axial facet joint interventions for chronic spinal pain: A narrative review
Wong MJ, Rajarathinam M, et al. — Can J Pain, 2023 · PMID 37214187
- Intra-articular Steroids vs Saline for Lumbar Z-Joint Pain: A Prospective, Randomized, Double-Blind Placebo-Controlled Trial
Kennedy DJ, Fraiser R, et al. — Pain Med, 2019 · PMID 30541041
- A pragmatic randomized prospective trial of cooled radiofrequency ablation of the medial branch nerves versus facet joint injection of corticosteroid for lumbar facet syndrome: 12 month outcomes
McCormick ZL, Conger A, et al. — Pain Med, 2023 · PMID 37578437
Published data describe average results in groups of patients and are not a prediction of an individual outcome. The indication for treatment must always be assessed during a consultation.
Risks, costs and opinions
The three questions patients ask most often before deciding, with clear answers.
What are the risks of lumbar facet joint injection?
It is an outpatient procedure performed with a thin needle under local anaesthesia and continuous ultrasound guidance, which makes it possible to see the needle, the target and the structures to avoid in real time. The most common issues are transient: pain or swelling for 24-48 hours, a small bruise. Joint infection is a rare event, prevented by sterile technique. In treatments with cortisone, facial flushing or a temporary rise in blood sugar may occur in diabetic patients. Personal risks and contraindications are assessed during the consultation.
How much does the lumbar facet joint injection cost?
The cost depends on the setting in which the procedure is performed: some treatments are available through the National Health Service or under agreement, others privately or through insurance. The quote is given clearly before scheduling the treatment, and includes the assessment, the procedure and the planned follow-up. During the consultation I tell you which pathway is available in your case: you do not have to decide before knowing the cost.
Does it really work? What patients and the literature say
The most frequent questions are "how long does the benefit last?" and "can I repeat it?". The answer depends on the diagnosis and the stage: some injections resolve the painful episode, others serve to open a window in which rehabilitation becomes effective. Experiences read in forums concern cases different from yours. During the consultation we review your imaging and I tell you frankly what to expect, how many sessions may be needed and when another approach is better.
Want to know if it is right for you?
At the first consultation we review your clinical history and previous imaging together.