What to Know About Lumbar Facet Joint Injections

Medically Reviewed by Poonam Sachdev on October 19, 2022
5 min read

When you have back problems, it can be hard to function during daily activities. It can be even harder to participate in leisurely activities that help you relax and enjoy yourself. Everyday chores such as cleaning and activities such as golfing, gardening, and spending time with your loved ones become almost impossible. Damage to the lumbar facet joints is commonly associated with this kind of chronic lower back pain. In fact, up to 45% of patients experiencing lower back pain also have issues with their lumbar facet joints. If you have back pain or decreased flexibility, you might want to consider receiving lumbar facet joint injections or lumbar facet steroid injections. 

Of course, you might first be wondering what your lumbar facet joints are, how these injections work, and what the associated risks might be. If so, read on to find out.

Lumbar facet joints are also known as zygapophysial joints or Z-joints. Lumbar refers to the lower portion of your back, a term used because these joints are located behind each vertebra or spinal column bone.

Like other joints, such as the knee joint, the lumbar facet joints permit bones to rotate.  The lumbar joints are responsible for twisting, bending, and aligning the spine. Joint facet capsules also provide the lumbar facet joints with a lubricating fluid that makes movement easier.

Many painful conditions can affect the lumbar facet joints, though, including facet arthropathy, an arthritic condition that can cause lower back pain.

A lumbar facet injection is also referred to as a lumbar facet joint block. In this procedure, a local anesthetic agent (numbing medicine) is injected into your back: specifically, the small joints near the vertebrae near the spine. Depending on your condition and how many joints are involved, several injections may be needed. 

Lumbar facet injections are a standard procedure performed as part of spinal medicine. These injections are typically used on patients who are experiencing arthritic pain in their facet joints. Patients with mechanical lower back pain may also benefit from lumbar facet injections.  

Trained clinicians will perform the lumbar facet injection, typically nurses or doctors specializing in pain, spinal intervention, interventional radiology, or physical medicine and rehabilitation.

As with any medical procedure, knowing the potential side effects of lumbar facet injections is essential. Though these side effects are rare, they include: 

  • Allergic reaction (can be immediate or delayed) 
  • Infection
  • Bleeding
  • Injury to the nerve 
  • A temporary pain increase 
  • High blood sugar levels
  • Temporary vaginal spotting 
  • Temporary facial flushing 
  • Stomach ulcers 
  • Severe hip arthritis (avascular necrosis) 
  • Cataracts 
  • Increased appetite 
  • Irritability 
  • A decrease in bone density

You must take the necessary steps to prepare for the lumbar facet injection procedure, including measures that will take place before, during, and after the process is complete. Additionally, some patients should avoid facet injections, including: 

  • Patients with allergies to local anesthetics, contrast agents, and steroids 
  • Patients who are experiencing local or systemic bacterial infections 
  • Patients who are currently pregnant 
  • Patients with bleeding disorders 
  • Patients who have spinal tumors or infections 
  • Patients with uncontrolled diabetes or congestive heart failure

Before the Procedure

Your doctor will evaluate your medical history, review the potential risks and benefits, and answer your questions. You must inform your doctor if you have bleeding disorders or are taking blood thinners before your procedure. Additionally, certain medications, such as aspirin, may increase the risk of bleeding complications. If you’re taking blood thinners or other medications, you will be asked to talk to your primary doctor about whether you can safely stop prior to the procedure. 

On the day of your procedure, it’s essential that you complete the following tasks: 

  • Shower and wash your skin with regular soap
  • Avoid using skin lotions and medicated creams around the area of the injection 
  • Dress in dark and loose clothing, including underwear 
  • Arrive at the treatment center 30 minutes early
  • Have someone with you who can drive you to and from your appointment 
  • Have an updated medication and allergy list with you 
  • Have your latest imaging studies and report on hand

A nurse will evaluate your medications and allergies and will perform screening questions. Then, the nurse will prep you for your injection. An IV line may be used, especially if this is your first spinal procedure. 

Your blood pressure and sugar levels will be tested, as they need to be in safe ranges before the procedure can occur. 

During the Procedure

The lumbar facet injection procedure typically lasts 10 to 30 minutes. Sedation is rarely used, so you will likely be awake during the injections.

You will be asked to change into a hospital gown and must review and sign a consent form before the procedure. A nurse will escort you to the procedure room and instruct you to lie facedown. You will have a blood-pressure-and-heart-rate monitor connected to your arm and finger. 

You may hear your doctor instruct their staff to perform specific tasks. They will also provide you with step-by-step instructions throughout the procedure. 

To prepare for the injection, your skin will be disinfected with a disinfectant or antiseptic agent. A sterile piece of paper or plastic will then be laid on your skin. 

An X-ray device will be guided along your spine to pinpoint the target area, and your skin will be marked and anesthetized with a numbing agent. You may feel a slight pinch or burning sensation at these sites. You may also feel pressure or a twitch in your muscles. 

Next, a contrast agent is injected, followed by an injection of steroid medication. You may feel temporary pressure against your spine. The needle will be removed, the skin will be cleaned, and a bandage will be applied to the injection site. 

You will then be escorted back to the recovery area, where you will be observed for 15 to 45 minutes. 

After the Procedure

If you were given one, your IV line will be removed. A nurse will review your vitals and provide you with discharge instructions. If you have questions, the nurse will answer them. 

You will be supplied with a pain log and told when to make a follow-up appointment, what activities should be avoided and for how long, when you can remove the bandages, and more. 

If you experience any side effects, such as shortness of breath, sudden weakness, allergic reactions, headaches, increased pain, and incontinence after the procedure, call your doctor immediately.