Key facts
- What they treat: chronic back, neck, and radicular (nerve root) pain — from facet joint arthritis, nerve root irritation, disc-related pain, and post-surgical scarring.
- How they're delivered: under CT or fluoroscopic image guidance, so the needle is confirmed at the exact target before any medication is injected.
- Main categories: facet joint injections and medial branch blocks; transforaminal and epidural (perineural) injections; and a transfacet lumbar approach used in this practice as a better-tolerated alternative for perineural injection.
- Blood thinners: the approach to anticoagulation differs by procedure type — see our periprocedural anticoagulation guide for general reference.
Spinal injections and interventions use image guidance to deliver anti-inflammatory or diagnostic medication precisely to a specific structure in the spine — a facet joint, a nerve root, or the surrounding perineural space — rather than relying on surface landmarks alone. They're used both to diagnose exactly where spinal pain is coming from, and to treat it directly.
Facet joint injections and medial branch blocks
The facet joints are small paired joints at the back of each spinal level that can become arthritic and painful, particularly in the lumbar and cervical spine. A facet joint injection delivers anti-inflammatory medication directly into the joint, while a medial branch block targets the small nerves that carry pain signals from the joint — both performed under image guidance to confirm accurate needle placement.
Transforaminal and epidural (perineural) injections
Where pain is coming from an irritated or compressed nerve root — commonly from a disc herniation or foraminal narrowing — a perineural injection delivers medication around that specific nerve root. The conventional approach is transforaminal, entering through the neural foramen. This practice also offers a transfacet approach for lumbar perineural injections, which reaches the same target by directing the needle through the facet joint instead — avoiding the foramen and the radicular artery that runs through it entirely.
Why this matters clinically: the transfacet approach is strictly avascular, meaning it avoids the vascular complications occasionally associated with transforaminal injection, and in this practice's experience over several years has been consistently well tolerated. Read the full technical explainer: The transfacet approach to lumbar perineural injections.
Who these procedures suit
- Chronic lower back or neck pain attributed to facet joint arthritis
- Radicular (nerve root) pain — sciatica or nerve-related arm/leg pain — from disc herniation or foraminal stenosis
- Pain following spinal surgery, including scar tissue (fibrosis) around a nerve root
- Patients seeking a diagnostic injection to confirm the source of spinal pain before considering further treatment
A note on blood-thinning medication
Not all spinal injections carry the same bleeding-risk profile. Facet joint injections and medial branch blocks in the thoracic and lumbar spine are generally classified as low bleeding-risk procedures, while epidural, transforaminal, and cervical facet procedures are treated more conservatively given their proximity to the spinal canal. If you're on aspirin, a DOAC, warfarin, or another antiplatelet or anticoagulant medication, our interactive periprocedural anticoagulation guide gives a general starting point — though your specific plan should always be confirmed directly with our rooms.
Common questions
What are spinal injections used for?
Spinal injections are used to diagnose and treat pain arising from the facet joints, nerve roots, or surrounding structures of the spine — commonly for chronic lower back pain, sciatica, and radicular leg or arm pain.
What is the difference between a facet joint injection and an epidural injection?
A facet joint injection or medial branch block targets the small joints at the back of the spine, while an epidural or transforaminal injection targets the space around a nerve root. They treat different sources of pain and carry different risk profiles.
Are spinal injections safe if I take blood thinners?
It depends on the specific procedure and medication. Facet joint injections in the thoracic and lumbar spine are generally low bleeding-risk, while epidural or transforaminal injections carry a higher bleeding-risk classification given their proximity to the spinal canal. See our periprocedural anticoagulation guide for general reference, and discuss your specific medications with our rooms.
What is the transfacet approach to lumbar injections?
The transfacet approach reaches the perineural or epidural space by directing the needle through the facet joint rather than through the neural foramen used in a standard transforaminal injection. It avoids the radicular artery entirely, and in this practice's experience has been notably well tolerated.
Next step
Considering a spinal injection?
Ask your GP about a referral, or get in touch directly to discuss suitability and technique.
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