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Lumbar Facet Injection

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Lumbar Facet Injection

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Lumbar Facet Injection with steroids is utilized to treat Chronic capsulitis of the facet joint in the lumbar spine. This condition is characterized by low back pain that can be unilateral or bilateral, occasionally accompanied by a dull, vague ache radiating down the leg(s). The clinical presentation may include limited extension, side flexions, and combined extension with side flexion towards the painful side.

Facet joint pain is believed to be the cause of pain in approximately 67% of individuals experiencing neck pain, 48% of those with thoracic pain, and up to 45% of patients with low back pain. The pain associated with facet joint issues is thought to originate from various factors such as injury or inflammation resulting from degenerative arthritis, capsular distension or defects, instability, and nerve compression due to osteophytes.

See Also: Facet Joint Dysfunction

Related Anatomy

The zygapophyseal joints, also known as the lower lumbar facet joints, are situated on the sides of the spinous processes. At the L3 level, they are about the width of one finger away, while at L4, it’s approximately one-and-a-half finger widths, and at L5, it’s around two finger widths.

Although they cannot be directly felt through palpation, their location can be determined by drawing a vertical line along the center of the spinous processes and horizontal lines between each process. To access the posterior capsule of the joint, the needle should be inserted at the correct distance laterally on the horizontal line corresponding to that specific level.

Equipment Needed

  • Syringe: 1 ml
  • Needle: Spinal, 22 gauge / 3–4 inches / (75–90 mm)
  • Kenalog 40: 40 mg
  • Total volume: 1 ml

Lumbar Facet Injection Technique

  • Begin by positioning the patient in a prone position on a small pillow to assist in identifying the desired spinous interspace.
  • Locate and mark one or more tender levels on the patient’s back.
  • Insert the needle vertically at the first chosen level.
  • Adjust the angle of the needle slightly upward and toward the midline, then slowly advance it until it reaches the bone.
  • Perform aspiration to confirm that the needle tip is not within the intrathecal space or a blood vessel.
  • Administer the solution into the capsule.
  • Withdraw the needle and, if needed, repeat the process on the opposite side and at different levels.

To maintain activity, it is advisable to minimize excessive movement. Regularly incorporate exercises that strengthen the abdominal muscles and promote mobility. Occasional stretching of the hamstrings can enhance flexibility, and utilizing lumbar support during activities can provide additional back support.

facet joint injection


There are no absolute contraindications to facet joint injection besides patient refusal.

Relative contraindications to spinal facet injections include:

  1. patients with systemic or local infection over the injection site,
  2. coagulopathy or bleeding diathesis (particularly with the cervical region),
  3. allergy to contrast agent or medications,
  4. a neurologic disorder that may be masked by procedure,
  5. pregnancy.

While direct access to the joint may not be feasible, controlled studies have demonstrated therapeutic effectiveness by introducing the solution into and around the joint capsule. It is common to administer these injections under imaging guidance, but it’s important to consider the associated extra cost.

spinal facet injection with fluoroscopy
L4-L5 facet joint injection: Intra-articular lumbar facet joint steroid injection. C-arm fluoroscopy-guided intra-articular contrast injection into the left L4-5 facet joint.

References & More

  1. Injection Techniques in Musculoskeletal Medicine. A Practical Manual for Clinicians In Primary And Secondary Care. Fifth Edition
  2. Le DT, Alem N. Facet Joint Injection. [Updated 2023 Feb 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572125/
  3. Peh W. Image-guided facet joint injection. Biomed Imaging Interv J. 2011 Jan-Mar;7(1):e4. [PMC free article] [PubMed]
  4. Stallmeyer MJ, Ortiz AO. Facet blocks and sacroiliac joint injections. Tech Vasc Interv Radiol. 2002 Dec;5(4):201-6. [PubMed]
  5. Manchikanti L, Kaye AD, Soin A, Albers SL, Beall D, Latchaw R, Sanapati MR, Shah S, Atluri S, Abd-Elsayed A, Abdi S, Aydin S, Bakshi S, Boswell MV, Buenaventura R, Cabaret J, Calodney AK, Candido KD, Christo PJ, Cintron L, Diwan S, Gharibo C, Grider J, Gupta M, Haney B, Harned ME, Helm Ii S, Jameson J, Jha S, Kaye AM, Knezevic NN, Kosanovic R, Manchikanti MV, Navani A, Racz G, Pampati V, Pasupuleti R, Philip C, Rajput K, Sehgal N, Sudarshan G, Vanaparthy R, Wargo BW, Hirsch JA. Comprehensive Evidence-Based Guidelines for Facet Joint Interventions in the Management of Chronic Spinal Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines Facet Joint Interventions 2020 Guidelines. Pain Physician. 2020 May;23(3S):S1-S127. [PubMed]
  6. Kwak, Dong & Kwak, Sang & Lee, Ah & Chang, Min. (2019). Outcome of intra‑articular lumbar facet joint corticosteroid injection according to the severity of facet joint arthritis. Experimental and Therapeutic Medicine. 18. 10.3892/etm.2019.8031.
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