A lumbar facet injection with steroids is a treatment for chronic capsulitis of the facet joints in the lower spine. This condition typically causes lower back pain that may occur on one or both sides, sometimes accompanied by a dull, vague ache that radiates into one or both legs. Clinically, it can present with limited extension, lateral bending, and combined extension with lateral bending toward the painful side.
Facet joint pain is believed to be the source of symptoms in approximately 67% of patients with neck pain, 48% of those with thoracic pain, and up to 45% of individuals with lower back pain. The pain associated with facet joint issues is thought to result from various factors, including injury or inflammation due to degenerative arthritis, capsular stretching or defects, instability, and nerve compression caused by osteophytes.
The zygapophyseal joints, also known as the lower lumbar facet joints, are located lateral to the spinous processes. At the L3 level, they are approximately one fingerbreadth away; at L4, about one and a half fingerbreadths; and at L5, roughly two fingerbreadths.
While these joints cannot be directly palpated, their position can be estimated by drawing a vertical line along the midline of the spinous processes and horizontal lines between each process. To access the posterior joint capsule, the needle should be inserted at the correct lateral distance on the horizontal line corresponding to the target level.
To maintain function, it is advisable to minimize excessive movement. Incorporate regular exercises that strengthen the abdominal muscles and promote mobility. Occasional hamstring stretching can improve flexibility, and using a lumbar support during activities can provide additional back support.
Aside from patient refusal, there are no absolute contraindications to facet joint injection.
Relative contraindications for spinal facet injections include:
Although direct access to the joint may not always be possible, controlled studies have demonstrated therapeutic efficacy by depositing the solution into and around the joint capsule. These injections are commonly administered under image guidance, but it is important to consider the additional costs involved.
