What Are Facet Joints and Why Do They Cause Pain?
Facet joints (zygapophyseal joints) are paired synovial joints located at the posterior aspect of each vertebral level — from C2-C3 in the cervical spine to L5-S1 in the lumbar spine. They guide and limit spinal motion, bearing approximately 20–40% of compressive load in the lumbar spine and up to 70% in extension. Like all synovial joints, they are lined with cartilage and enclosed in a joint capsule filled with synovial fluid.
With age, repetitive loading, trauma, or degenerative disc disease, facet joint cartilage erodes, the joint capsule becomes inflamed, and osteophytes (bone spurs) form — producing a pattern of axial neck or back pain that is characteristically worse with extension and rotation, often radiating to the shoulders, buttocks, or thighs (but rarely below the knee, distinguishing it from disc-related radiculopathy).
Facet Joint Injection vs. Medial Branch Block: What's the Difference?
Intra-Articular Facet Injection
Medication is injected directly into the facet joint space. Provides both diagnostic confirmation (pain relief confirms the joint as the source) and therapeutic benefit (steroid reduces inflammation). Best for acute or subacute facet joint pain.
Medial Branch Block
Local anesthetic is injected adjacent to the medial branch nerve that innervates the facet joint — rather than into the joint itself. Primarily diagnostic: ≥50–80% relief confirms candidacy for radiofrequency ablation. Required before RFA.
The Facet Joint Treatment Pathway
Clinical Evaluation & Imaging
Physical examination, pain pattern analysis, and MRI/CT review to identify facet joint involvement and rule out disc herniation or other pain generators.
Intra-Articular Facet Injection
Fluoroscopy-guided injection of corticosteroid + local anesthetic into the affected facet joint(s). Provides therapeutic relief and diagnostic confirmation.
Medial Branch Blocks (If RFA Planned)
If sustained relief is needed, medial branch blocks confirm nerve-level candidacy for radiofrequency ablation — the definitive long-term treatment for facet joint pain.
Radiofrequency Ablation
For confirmed candidates, RFA interrupts the medial branch nerve — providing 6–18 months of sustained relief without repeated injections.
Chronic Neck or Back Pain from Facet Joints?
Our specialists at NYC Pain Management in Rego Park perform fluoroscopy-guided facet joint injections and medial branch blocks. Most insurance plans accepted.