Image-Guided Lumbar Facet Joint Corticosteroid Injections: Indications and Efficacy

Facet joints, otherwise known as zygapophysial joints, are synovial joints found between the vertebrae of the spine. These joints can be a source of chronic back pain in some patients, leading clinicians to seek out targeted interventions. One such treatment is the lumbar facet joint corticosteroid injection, which has been shown to provide pain relief for select patients when conducted under image guidance. This article explores the indications for this procedure and the evidence supporting its efficacy.


Indications for Image-Guided Lumbar Facet Joint Injections


  1. Facet Joint Syndrome (FJS): This is characterized by pain originating from the facet joint due to arthritic changes, trauma, or other degenerative processes. The pain can be localized or referred to areas like the buttocks or thighs. FJS is typically diagnosed using clinical findings and confirmed with diagnostic medial branch blocks.


  1. Spondylolisthesis: Patients with mild spondylolisthesis, which is a slippage of one vertebra over another, might have facet joint pain due to the altered biomechanics and strain on the facet joint.


  1. Post-surgery pain: Patients who have persistent pain following back surgeries, like lumbar fusion, might benefit from facet joint injections if the facet joint is identified as a pain generator.


Efficacy of the Procedure


  1. Short-Term Relief: Multiple studies have indicated that facet joint injections can provide immediate pain relief. A randomized trial demonstrated significant pain reduction and functional improvement up to one month post-injection for patients with lumbar facet joint pain.


  1. Long-Term Benefits: The long-term benefits are variable. While some patients report pain relief for several months, others may find the effects diminish after 6-8 weeks. The use of image guidance increases the precision and likelihood of delivering the corticosteroid to the exact location of inflammation, potentially improving outcomes.


  1. Diagnostic and Therapeutic Value: Beyond the therapeutic effects, the injections can serve a diagnostic purpose. If a patient experiences pain relief following the injection, it confirms that the facet joint is a pain generator, which can guide further treatment decisions.




Lumbar facet joint corticosteroid injections are a valuable tool in the management of chronic low back pain arising from the facet joints. Indications for the procedure include facet joint syndrome, spondylolisthesis, and post-surgery pain. While the injections offer both diagnostic and therapeutic benefits, their efficacy varies among patients. The use of image guidance ensures accurate placement of the injection, potentially optimizing results. Further research is needed to determine the best candidates for the procedure and to refine techniques to maximize long-term benefits.