Facet Joint Injections in Miami
Facet joint injections are a targeted, minimally invasive procedure used to diagnose and treat pain originating from the facet joints of the spine. The facet joints are small, paired joints located along the back of the spine that allow for movement and provide stability. When these joints become inflamed or arthritic, they can be a significant source of neck pain, back pain, and referred pain into the shoulders, buttocks, or thighs.
At our Miami clinic, Dr. William Bonner performs all facet joint injections under fluoroscopic (X-ray) guidance to ensure precise needle placement and maximize both diagnostic accuracy and therapeutic benefit.
What Are the Facet Joints?
The facet joints (also called zygapophyseal joints) are small joints that connect each vertebra to the one above and below it. Every level of the spine has a pair of facet joints — one on the left and one on the right. These joints are lined with cartilage, surrounded by a joint capsule, and contain synovial fluid, similar to other joints in the body like the knee or hip.
The facet joints serve several important functions:
- Guiding and limiting spinal motion (flexion, extension, and rotation)
- Bearing a portion of the spine’s compressive load
- Stabilizing the spine during movement
Like any joint, facet joints can develop arthritis (facet arthropathy), become inflamed, or sustain injury — all of which can cause pain that may be difficult to distinguish from other spinal conditions without proper evaluation.
What Does Facet Joint Pain Feel Like?
Facet joint pain can vary depending on which region of the spine is affected. Common patterns include:
Cervical Facet Pain (Neck)
- Pain in the neck, upper back, or between the shoulder blades
- Headaches, often at the base of the skull
- Pain that worsens with looking up or turning the head
- Stiffness and reduced range of motion in the neck
Lumbar Facet Pain (Low Back)
- Low back pain, often on one or both sides
- Pain that refers into the buttocks or upper thighs (but typically does not travel below the knee)
- Pain that worsens with extension (arching the back), twisting, or prolonged standing
- Stiffness, especially in the morning or after prolonged sitting
An important distinction is that facet joint pain typically does not cause radiating pain down the leg past the knee or down the arm past the shoulder — those patterns are more suggestive of nerve root irritation, which may be better addressed with an epidural steroid injection. This is why accurate diagnosis matters.
Conditions That May Benefit From Facet Joint Injections
- Facet joint arthropathy (facet arthritis)
- Facet joint syndrome
- Chronic neck pain without radiculopathy
- Chronic low back pain without radiculopathy
- Spine pain related to degenerative changes
- Spinal stenosis with a facet component
- Post-injury or post-surgical spine pain with a suspected facet source
Facet Joint Injections: Diagnostic and Therapeutic
One of the unique aspects of facet joint injections is that they serve a dual purpose — both diagnostic and therapeutic:
Diagnostic Role
Facet joint pain can be difficult to diagnose based on symptoms and imaging alone, because MRI and X-ray findings of facet arthropathy are extremely common in adults and do not always correlate with pain. A facet joint injection (or a medial branch block, which targets the nerves that supply the facet joint) can confirm whether the facet joint is the actual source of pain. If the injection provides significant, temporary relief, it supports the diagnosis that the facet joint is contributing to your symptoms.
Therapeutic Role
When a corticosteroid is included in the injection, it delivers a direct anti-inflammatory effect to the joint, which can provide weeks to months of pain relief. For some patients, this relief — combined with physical therapy — is sufficient. For patients who respond well diagnostically but need longer-lasting relief, the injection may serve as a gateway to radiofrequency ablation (RFA), a procedure that can provide relief lasting 6 months to a year or more.
The Facet Joint Treatment Pathway
Facet joint pain is often treated in a stepwise fashion. Understanding this pathway can help you know what to expect:
Step 1: Diagnostic Block (Facet Joint Injection or Medial Branch Block)
A small amount of local anesthetic (with or without steroid) is injected into the facet joint or along the medial branch nerves that supply it. If you experience significant pain relief during the hours after the injection, this confirms the facet joint as a pain source. Many protocols require two separate diagnostic blocks on different days to confirm the diagnosis before proceeding to the next step.
Step 2: Therapeutic Injection
If the diagnostic block confirms facet-mediated pain, a therapeutic injection with corticosteroid may be performed to provide longer-lasting relief. Some patients achieve adequate relief with periodic injections combined with rehabilitation.
Step 3: Radiofrequency Ablation (for Longer-Lasting Relief)
For patients who respond positively to diagnostic blocks but need more durable relief, radiofrequency ablation (RFA) uses heat energy to disrupt the medial branch nerves that transmit pain from the facet joint. RFA can provide relief lasting 6 to 12 months or longer, after which the nerves may gradually regenerate and the procedure can be repeated if needed.
What to Expect During a Facet Joint Injection
The procedure is performed in-office and typically takes 15 to 30 minutes:
- You are positioned lying face down on a procedure table
- The skin over the injection site is cleaned and numbed with local anesthetic
- Using fluoroscopy (live X-ray), Dr. Bonner guides a thin needle directly into the target facet joint or to the medial branch nerve
- A small amount of contrast dye is injected to confirm accurate needle placement
- The diagnostic and/or therapeutic medication is delivered
- The entire injection takes only a few minutes once the needle is positioned
- You are monitored briefly and then go home the same day
After the procedure, you may be asked to track your pain levels over the next several hours to help determine whether the facet joint was the source of your pain. This feedback is critical for guiding the next steps in your treatment plan.
Why Is Fluoroscopic Guidance Essential?
Facet joints are small structures that cannot be accurately targeted without imaging. Fluoroscopic guidance allows Dr. Bonner to visualize the spine in real time, confirm needle position with contrast dye, and deliver the medication precisely into the joint or along the medial branch nerve. This is essential for both diagnostic accuracy and therapeutic effectiveness.
Without image guidance, the diagnostic value of the injection is unreliable — if the needle is not in the correct location, a negative response does not truly rule out the facet joint as a pain source. Dr. Bonner performs all facet joint injections under fluoroscopy as the standard of care.
Facet Joint Injections vs. Epidural Steroid Injections: Which Do I Need?
One of the most common questions patients have is whether they need a facet injection or an epidural injection. The answer depends on the source of your pain:
| Facet Joint Injection | Epidural Steroid Injection | |
| Pain Source | Facet joint (joint itself) | Nerve root (pinched or inflamed nerve) |
| Typical Pain Pattern | Axial pain (neck or back); may refer to shoulders, buttocks, or upper thighs | Radiating pain down the arm or leg (radiculopathy/sciatica) |
| Target | Inside the facet joint or medial branch nerve | Epidural space around spinal nerves |
| Diagnostic Value | Confirms facet joint as pain source | Therapeutic primarily; some diagnostic value |
| Follow-Up Option | Radiofrequency ablation (RFA) for longer-lasting relief | Regenerative medicine or repeat injection |
In some patients, both facet joint pain and nerve root irritation may coexist, and a combination of treatments may be appropriate. Dr. Bonner will determine the best approach based on your examination, imaging, and symptom pattern.
Who Is a Good Candidate for a Facet Joint Injection?
You may be a candidate for a facet joint injection if you:
- Have chronic neck or back pain that has not responded adequately to physical therapy and medication
- Have pain that is primarily axial (in the spine) rather than radiating down an arm or leg
- Have pain that worsens with extension, twisting, or prolonged standing
- Have imaging findings suggestive of facet arthropathy (though imaging alone cannot confirm the diagnosis)
- Need a diagnostic procedure to determine whether the facet joints are contributing to your symptoms
- Are considering radiofrequency ablation and need a confirmatory diagnostic block first
A thorough evaluation including medical history, physical examination, and imaging review is essential before any injection is performed.
Frequently Asked Questions About Facet Joint Injections
Is a facet joint injection painful?
Most patients report mild discomfort from the initial numbing injection. Once the area is anesthetized, the facet joint injection itself typically causes a brief sensation of pressure. The procedure is generally well-tolerated and takes only a few minutes.
How quickly will I know if the injection worked?
For diagnostic purposes, you may notice relief within minutes to hours after the injection due to the local anesthetic. You will be asked to track your pain levels during this time. The steroid component, if included, typically takes several days to reach full effect.
How long does relief from a facet joint injection last?
This varies. The local anesthetic wears off within hours (this is the diagnostic component). If a steroid is included, therapeutic relief may last weeks to several months. For longer-lasting relief, radiofrequency ablation may be recommended based on your response to the diagnostic block.
What is the difference between a facet joint injection and a medial branch block?
A facet joint injection places medication directly inside the facet joint. A medial branch block targets the small nerves (medial branches) that carry pain signals from the facet joint to the brain. Both can serve diagnostic and therapeutic purposes. Medial branch blocks are specifically used as the diagnostic step before radiofrequency ablation.
How many facet joint injections can I have?
The number of injections is individualized based on your condition and response. If facet injections provide consistent but temporary relief, radiofrequency ablation may be a better long-term option than repeated injections.
Are there risks or side effects?
Facet joint injections are generally considered safe when performed under fluoroscopic guidance. Potential side effects include temporary soreness at the injection site, temporary increase in pain, and the general risks associated with corticosteroid use. Serious complications are rare.
Can facet joint pain be treated with regenerative medicine?
In some cases, regenerative treatments like PRP may be considered for facet joint pain as part of a comprehensive treatment plan. Dr. Bonner can discuss whether regenerative options are appropriate for your specific condition during your consultation.
Schedule a Consultation
If you are experiencing neck pain, low back pain, or facet joint pain and want to determine whether a facet joint injection is appropriate for you, we are here to help.
Contact our Miami clinic to schedule an appointment with Dr. Bonner, or book online through ZocDoc for available appointment times (if you do not see availability, please reach out to us directly at 786-522-4959).