What are facet injections and radiofrequency ablation?
The facet joints are the small paired joints at the back of the spine that guide and steady its movement. Like any joint, they can become worn or arthritic and generate pain - typically felt in the back or neck, and often worse when you arch, twist, or stand for a while. These procedures target that specific source of pain.
A facet joint injection places a corticosteroid in or around the joint to calm inflammation. A closely related step, a medial branch block, uses local anesthetic on the tiny nerves that carry pain from the joint - mainly to confirm the facet joints really are the culprit. If those blocks give clear, though temporary, relief, radiofrequency ablation (RFA) can offer something longer lasting: a fine probe uses heat to interrupt those small nerves so they stop relaying pain.
What happens during the procedure
All of these are image-guided day-case procedures. Using fluoroscopy - live X-ray - the skin is numbed and a fine needle or probe is guided precisely to the joint or its medial branch nerves; no incision is needed. For RFA, the probe delivers a controlled dose of heat over a short period once the target is confirmed. Light sedation can be offered. Most appointments take well under an hour, and you rest briefly before going home.
Benefits and considerations
These procedures may add diagnostic information and may reduce pain. The response and duration vary, and some people have little or no benefit. Treated medial branch nerves can regenerate after RFA, so symptoms may return. These procedures do not reverse the underlying joint changes.
What to expect afterwards
You will receive instructions based on the procedure and any sedation used. Temporary soreness or a pain flare can occur, and local tenderness may follow RFA. Record the change in your usual pain after a diagnostic block and seek advice for new weakness, fever or severe headache.
How we approach your care
- 01
Find the true source
We begin with a thorough history and examination, supported by imaging where appropriate, to pinpoint the precise source of the problem.
- 02
Consider appropriate options
Where clinically appropriate, we consider established non-surgical options before surgery. The plan depends on the diagnosis, symptoms, health and priorities of the individual patient.
- 03
A plan built around you
Every step is explained clearly, so you always understand your options and what comes next.
This may help if
- Your pain sits mainly in the back or neck rather than radiating down a limb
- Arching, twisting, or standing for a while tends to make it worse
- Facet joint wear or arthritis is suspected as the source
- A diagnostic block has confirmed the facet joints are driving your pain (for RFA)
Suitability can only be assessed after reviewing your symptoms, examination, relevant imaging and previous treatment.
Common questions
What is the difference between a facet injection and radiofrequency ablation?
A facet injection places medication in or around the joint. A medial branch block uses local anesthetic to test the nerves carrying pain from the joint. If the clinical response supports it, radiofrequency ablation (RFA) uses heat to interrupt those small nerves.
Why do I need a diagnostic block before RFA?
A medial branch block temporarily numbs the nerves carrying pain from the facet joints. The response is recorded and interpreted with your symptoms and examination when deciding whether RFA is appropriate.
How long does the relief last?
The response and duration vary. Some people improve, some have temporary benefit and others have little or no change. Facet nerves can regenerate after RFA, so symptoms may return.
Do the nerves grow back after radiofrequency ablation?
Yes. Medial branch nerves can regenerate after RFA, so pain may return. A repeat procedure is considered only after reassessment.
Will this cure my facet joint arthritis?
No. These procedures may help assess or manage pain but do not reverse joint wear. They may form one part of a plan that also includes activity guidance, medication or physiotherapy.
Is the procedure painful?
The skin is numbed with local anesthetic first, so most people feel pressure rather than sharp pain, and light sedation can be offered. There is no incision - only a fine needle or probe guided under X-ray. With RFA, brief localised tenderness afterwards is common before the benefit settles in.