Facet Joint Injection, Thoracic Spine



  • Injection of long-acting anesthetic ± corticosteroid into thoracic facet joint


  • Preprocedure imaging

    • Correlate level with prior imaging

      • Evaluate for 12 ribs &/or transitional vertebral anatomy

  • Indications for procedure and future treatment plan

    • Is facet joint injection or medial branch block more appropriate?


  • Fluoroscopy

    • Align margins of facet joint to maximize visualization of joint space

    • Contrast is useful to evaluate intraarticular injection during fluoroscopy-guided facet injection

  • CT

    • Gantry angulation may be necessary to “open” facet joints

    • Sagittal reformats helpful for determining correct level and angulation of needle

Post Procedure

  • Improvement/relief of pain referable to facet joint(s) injected

    • < 100% pain relief decreases likelihood of successful outcome following facet neurolysis/radiofrequency ablation


  • Most feared complications

    • Spinal cord/nerve root injury

    • Pneumothorax

    • Epidural hematoma

Degenerated Facets

Needle Placement

Intraarticular Needle Placement

Intraarticular Needle Placement


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