Facet Joint Injections

Fluoroscopically guided facet joint injections to reduce inflammation in the arthritic joints of the neck, mid-back, and lower back — performed by board-certified pain management physicians at Remix Medical in Houston, TX.

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The facet joints are the small paired joints at the back of every spinal segment. They guide and limit motion, and like every other synovial joint in the body, they develop arthritis. When they do, they produce a deep, aching, poorly localized pain that worsens when you arch backward and eases when you bend forward.

A facet joint injection delivers corticosteroid and local anesthetic directly into the joint capsule under fluoroscopic guidance. Unlike a medial branch block, which anesthetizes the nerves supplying the joint, this places medication inside the joint itself.

It serves two purposes: reducing intra-articular inflammation, and helping confirm that the joint is contributing to your pain.

Facet joints refer pain in reproducible patterns:

Cervical facets — neck pain radiating to the shoulder, shoulder blade, or base of the skull
Thoracic facets — mid-back pain, occasionally wrapping toward the ribs
Lumbar facets — low back pain radiating to the buttock and posterior thigh, characteristically stopping above the knee

Pain that travels below the knee, or into the hand, points away from the facet joint and toward a nerve root.

Both target facet-mediated pain. The intra-articular injection is often chosen when inflammation within the joint is prominent, such as in an acute flare or an inflammatory arthritis. The medial branch block is preferred when the goal is to determine candidacy for radiofrequency ablation, since the ablation targets those same nerves.

Your physician will explain which pathway fits your presentation rather than defaulting to one.

Back and neck pain that worsens with extension and eases with flexion has a specific likely cause and a specific set of treatments.

How it's performed

Under live fluoroscopic guidance, the patient is positioned to open the target facet joint. After skin anesthesia, a needle is advanced into the joint capsule and correct intra-articular placement is confirmed with a small volume of contrast. A mixture of corticosteroid and local anesthetic is then injected into the joint.

How to prepare

Arrange a driver. Hold anticoagulants only as directed by the prescribing physician. Bring recent spine imaging and a current medication list. Notify the office of any active infection, fever, or uncontrolled diabetes.

What to expect after

Ice the injection site 20 minutes every 2 to 3 hours on the first day. Avoid heavy lifting and strenuous activity for 24 hours. A temporary increase in pain for 1 to 2 days is common. Monitor blood glucose if diabetic. Report fever, spreading redness, severe headache, or new weakness.

Outcome

Patients with facet-mediated pain typically experience reduced axial neck or back pain lasting weeks to several months, often sufficient to progress with physical therapy or to justify proceeding to radiofrequency ablation for longer-term relief.

Your physician

Your pain management at Remix Medical.

Every clinician at Remix Medical is board-certified and owns the practice — so the physician in your exam room is the one making decisions about your care.

Raju Mantena, DO
Pain Medicine Physician
Medical Center — South Freeway · Montrose — Upper Kirby · Pearland
Board certifiedAccepting newBook

Specialty: Pain Management
Type: Procedure
Body location: Cervical facet joints, thoracic facet joints, lumbar facet joints, zygapophyseal joints
CPT code: 64490 (cervical/thoracic, single level), 64491 (second level, add-on), 64492 (third level and beyond, add-on); 64493, 64494, 64495 (lumbar/sacral, first, second, third+ levels); 77003 (fluoroscopic guidance, when reported separately)

Also known as: Facet Block, Zygapophyseal Joint Injection, Intra-Articular Facet Injection, Facet Joint Block

This page is for general education and is not a substitute for medical advice. Whether a given procedure is appropriate depends on your individual evaluation. Contact a Remix Medical clinician to discuss your care.

Updated July 9, 2026.

Facet Joint Injections