Chronic spine
pain poses a peculiar diagnostic and therapeutic challenge due to multiple
pain sources, overlapping clinical features and nonspecific radiological findings. Facet joint injection is an interventional
pain management tool for facet-related spinal
pain that can be effectively administered by a radiologist. This technique is the gold standard for identifying facet joints as the source of spinal
pain. The major indications for facet
injections include strong clinical suspicion of the facet syndrome, focal tenderness over the facet joints,
low back pain with normal radiological findings,
post-laminectomy syndrome with no evidence of
arachnoiditis or recurrent disc disease, and persistent
low back pain after
spinal fusion. The
contraindications are more ancillary, with none being absolute. Like any synovial joint degeneration,
inflammation and injury can lead to
pain on motion, initiating a vicious cycle of physical deconditioning, irritation of facet innervations and
muscle spasm. Image-guided injection of
local anesthetic and
steroid into or around the facet joint aims to break this vicious cycle and thereby provide
pain relief. This outpatient procedure has high diagnostic accuracy, safety and reproducibility but the therapeutic outcome is variable.