Lumbar facet joint injection

What is a lumbar facet joint injection?

A lumbar facet joint injection, also known as a lumbar facet joint block, is a procedure that places local anaesthetic and sometimes steroid medication into or around one of the facet joints in your lower back. These joints can become painful due to arthritis, inflammation or degeneration.

You may find that many facet joint injections include a corticosteroid, which is why they are also commonly known as steroid injections for back pain.

What is a facet joint?

Your spine is made up of a column of bones called vertebrae. Each vertebra is connected to the next by:

• Facet joints: Which guide movement and help stabilise your spine.
• Intervertebral discs: Which act as cushions between the bones.

As you get older, wear and tear (osteoarthritis) can develop in these joints. This can cause pain in the lower back or refer pain into the buttocks, thighs or groin.

A facet joint injection helps your consultant at Nuffield Health confirm whether these joints are responsible for your symptoms, with the aim of helping reduce your inflammation and provide longer-lasting relief.

What types of facet joint injection are there?

• Diagnostic facet joint injection: This uses local anaesthetic only. If your pain improves immediately, it confirms the facet joint as the source.
• Therapeutic facet joint injection: Uses local anaesthetic and steroid to reduce inflammation and provide longer-lasting relief.
• Medial branch block: Targets the small nerves (medial branches) that supply the facet joints rather than the joint itself.

What conditions can a lumbar facet joint injection treat?

A lumbar facet joint injection may help diagnose or relieve:

• Facet joint inflammation
• Facet joint arthritis (osteoarthritis)
• Facet joint degeneration
• Lower back pain that worsens with twisting or leaning backwards
• Pain radiating into the buttocks or groin.

It is not typically used for sciatica or nerve compression.

What causes facet joint pain in the lower back?

Facet joints can become painful due to:

• Age-related wear and tear
• Osteoarthritis
• Inflammation
• Repetitive strain
• Poor posture or muscle imbalance
• Previous spinal injury.

Most lower back pain is not dangerous, but it can significantly affect your daily life, sleep and mobility. Persistent or worsening pain should be assessed by a specialist.

Symptoms of facet-related lower back pain

Symptoms may include:

• Localised lower back pain originating from the joints themselves, which can cause surrounding muscles to tighten or spasm
• Pain becomes worse when leaning backwards
• Morning stiffness or general joint stiffness
• Pain radiating into the buttocks or groin
• Pain that improves with sitting or bending forward.

Who is at risk?

• Adults over 40
• People with arthritis
• Those with physically demanding jobs
• Individuals with poor posture
• Anyone with a previous spinal injury.

Can lower back pain go away on its own?

Yes, many cases improve with rest, exercise and physiotherapy. A facet joint injection is considered when symptoms persist despite conservative treatment.

Why might I need a lumbar facet joint injection?

Your consultant may recommend a lumbar facet joint injection if:

• Your symptoms suggest facet joint involvement
• Physiotherapy or medication hasn’t improved your condition
• Imaging shows facet joint degeneration
• A diagnostic block (a type of medical procedure) is needed to confirm the pain source
• You require pain relief to support rehabilitation.

You may be suitable if:

• You have persistent lower back pain for more than 6–12 weeks
• Your pain is aggravated by twisting or leaning backwards
• You have localised tenderness over the facet joints
• You have no red-flag symptoms, such as bowel or bladder changes.

Who is not suitable for a lumbar facet joint injection?

A lumbar facet joint injection may not be recommended if:

• You have a bleeding disorder
• You have an active infection
• You have uncontrolled diabetes
• You are allergic to local anaesthetic or steroids
• You are pregnant (depending on clinical assessment)
• You have significant spinal instability.

Your consultant will discuss the safest option for you.

What are the alternatives to a lumbar facet joint injection?

Alternatives may include:

• Physiotherapy and exercise programmes
• Pain-relieving medication
• Medial branch block
• Radiofrequency ablation
• Lifestyle changes such as weight loss or posture correction
• Manual therapy.

Facet joint injection vs medial branch block: what’s the difference?

• A facet joint injection places medication inside the joint.
• A medial branch block places anaesthetic on the nerves that supply the joint.

Facet joint injections can be both diagnostic and therapeutic. Medial branch blocks are mainly diagnostic and are often used before radiofrequency ablation.

Facet joint injection vs radiofrequency ablation: what’s the difference?

• Facet joint injection provides temporary relief using anaesthetic and steroid.
• Radiofrequency ablation (RFA) uses heat to disrupt the medial branch nerves, offering longer-lasting relief (often 6–12 months). It’s usually considered after a successful medial branch block.

How can I prepare for a lumbar facet joint injection?

You’ll attend a pre-procedure assessment where the team will:

• Review your medical history
• Check your medications. If you are on blood thinners, you will be given specific advice about when to safely pause them.
• Discuss anaesthetic options
• Explain the procedure and answer questions.

Preparation in the days leading up to your injection can include:

• Follow any fasting instructions if advised
• Keep warm and let the team know if you feel unwell
• If you smoke, stopping now reduces complications
• Keep diabetes well controlled, if applicable.

What to bring on the day

• Comfortable, loose clothing
• Your medication list
• Any questions you’d like to ask your consultant.

What should I expect during a lumbar facet joint injection?

A lumbar facet joint injection usually takes less than 30 minutes and is performed using local anaesthetic.

During the procedure:

• A small cannula (a flexible tube) may be inserted into the back of your hand so medication can be given if needed
• You’ll be helped into position on the X-ray table
• The area of skin is cleaned with antiseptic
• Local anaesthetic is injected to numb the area
• A fine needle is guided into the facet joint using X-ray or ultrasound
• A small amount of contrast dye may be used to confirm the needle position
• The anaesthetic and steroid are then injected.

You may feel pressure or temporary discomfort during this procedure, but you’ll be monitored throughout.

My recovery after a lumbar facet joint injection?

Going home

Most patients go home shortly after the procedure. You will not be able to drive, so please arrange for someone to take you home.

Support at home

• Make sure to rest if you feel any fatigue or tiredness, it’s important to not overdo any chores or daily tasks.
• If you received sedation, do not drive, operate machinery or cook for 24 hours
• Avoid alcohol for 24 hours.

Driving and daily activities

• You can usually drive again after 24 hours
• Most people return to work the next day, depending on their job
• Avoid heavy lifting or strenuous activity for 48–72 hours
• Build up gentle exercise gradually.

Flying

You may be able to fly after 24–48 hours, but check with your consultant.

Tracking your progress

Keep a record of your pain levels – this helps your consultant plan your ongoing treatment.

What are the benefits of a lumbar facet joint injection?

• Helps confirm the source of your pain
• Reduces inflammation
• Provides pain relief
• Supports physiotherapy and rehabilitation
• Improves mobility and quality of life.

How soon will I feel the benefits?

• Local anaesthetic works within minutes
• Steroid injection may take 2–7 days to take full effect.

What are the risks and complications of a lumbar facet joint injection?

• Failure of the injection to relieve pain
• Temporary worsening of pain
• Backache or bruising
• Allergic reaction to local anaesthetic.

Rare complications may include:

• Infection
• Nerve injury
• Blood clots (deep vein thrombosis – DVT).

Contact your care team urgently if you develop:

• Fever or chills
• Increasing redness or swelling
• Severe pain
• Difficulty walking
• A new sense of numbness or weakness
• A loss of bladder or bowel control.

How much does a lumbar facet joint injection cost at Nuffield Health?

For pricing information, please get in touch with your local hospital. The hospital or your healthcare team will give you a fixed, all-inclusive price for the treatment following your initial consultation.