What Are Cervical Facet Joints?

Facet joints are small joints along the spine that allow your neck and back to move comfortably. Like other joints in the body, they can develop arthritis, inflammation, or wear-and-tear over time.

When these joints become inflamed, everyday movements—such as bending, twisting, looking up, standing, or walking—can trigger significant pain. This pain is carried to the brain by tiny nerves called medial branch nerves.

Cervical facet joint injections are a non-surgical, minimally invasive treatment designed to reduce inflammation and relieve pain caused by arthritis or irritation of these joints.

What Is the Goal of a Facet Joint Injection?

Facet joint injections can be used for treatment.

How it helps:

  • A small amount of steroid (anti-inflammatory medication) and local anesthetic is injected directly into the irritated joint.
  • The steroid reduces inflammation, often leading to improved movement and pain relief.
  • The local anesthetic may provide temporary, immediate pain relief.

Diagnostic purpose (medial branch involvement):

Sometimes facet injections are used to identify the exact source of pain.

If the pain improves after the injection, it helps confirm that the facet joint is the problem and may indicate that the patient could benefit from other treatments, such as radiofrequency ablation.

What to Expect During the Procedure

  • The procedure is done in a sterile procedure suite using X-ray guidance for accuracy.
  • You will lie on the procedure table while the skin is cleaned and numbed.
  • A small needle is guided to the facet joint(s) causing pain.
  • Once confirmed in the correct location, a small amount of steroid and anesthetic is injected.
  • After the procedure, you will rest in a recovery area briefly before going home.

After the Procedure

Follow the instructions provided at discharge:

  • Resume normal activity as tolerated.
  • You may be asked to perform movements that usually increase your pain—this helps determine whether the injection worked (for diagnostic cases).
  • You may shower, but do not soak in a bathtub, pool, or lake for 24 hours.
  • The care team will call you after the procedure to ask about your level of pain relief.

If Your Procedure Includes Sedation

If sedation is used, follow these guidelines:

  • No solid food for 8 hours before the procedure.
  • Clear liquids allowed until 2 hours before (water, broth, clear juices without pulp, tea, coffee without cream).
  • No gum, mints, candy, or carbonated drinks for 2 hours.
  • The care team will call beforehand to review your medications and explain which ones you should take.

Failure to follow these instructions may require rescheduling for safety.

Possible Risks

Facet joint injections are considered safe, but all procedures carry some risks.

Rare but possible risks include:

  • Pain or soreness at the injection site
  • Minor infection (<1%)
  • Temporary increase in pain
  • Bleeding, especially if taking blood thinners
  • Very rare nerve or spinal cord injury
  • Allergic reaction to medications
  • Inability to complete the injection due to anatomy

If you take blood thinners, notify your provider.

Common blood thinners include:

Warfarin (Coumadin), Plavix (Clopidogrel), Aspirin, Xarelto (Rivaroxaban), Heparin, Lovenox (Enoxaparin), Brilinta (Ticagrelor), and others.

Insurance Requirements

Most insurance companies require certain steps before approving facet joint injections. These commonly include:

  • Physical therapy or provider directed home exercise program (often at least 6 weeks)
  • Imaging, such as X-rays or MRI
  • Documentation showing that other conservative treatments have not improved symptoms

Our team will help guide you through this process.

Summary

Cervical facet joint injections are a safe, minimally invasive option for patients with neck pain caused by arthritis or inflammation of the facet joints. They can help reduce pain, improve mobility, and also serve as a diagnostic tool to identify the source of your pain. Relief may be temporary or long-lasting depending on your condition, and your provider will discuss next steps based on your results.