Facet Joint Injection

Excerpt

Facet joint injections are one of the most commonly performed procedures amongst all spinal interventions. Facet joint pain can arise from osteoarthritis, segmental instability, trauma, meniscoid impingement, and inflammatory synovitis. Patients with facet joint pain may present with symptoms of neck pain, back pain, and pain worsened with hyperextension, bending laterally, and rotation.

Facet mediated pain is typically axial in nature, with rare radiation into the upper extremities or lower extremities in cervical and lumbar facet disease, respectively. Therefore, a key diagnostic question to ask patients with suspected facet pain is, “Does your pain extend below the knee or beyond the elbow?” with positive responses decreasing the likelihood of facet disease as the putative source of pain. However, none of the above are specific for the diagnosis of facet disease. In addition, imaging in those with facet joint pain may be completely normal or show degenerative findings.

Ultimately, facet joint pain is a diagnosis of exclusion after other etiologies have been ruled out. Thus, performing facet joint injections under image guidance has become a valuable tool in diagnosing facet joint pain and may provide therapeutic benefits.