What You Should Know About Cervical Facet Joint Injections

Medically Reviewed By:

Dr. Chaz Fausel, MD

Dr. Chaz Fausel is a Denver-based interventional orthopedics specialist and Regenexx educator, trained at Emory and the Centeno-Schultz Clinic.

Neck pain and instability can arise from many sources. One often-overlooked contributor is the cervical facet joint. These small joints guide and steady neck movement. When they become irritated or worn, they may cause persistent discomfort, stiffness, or pain that travels into the shoulders and upper back.

Cervical facet joint injections help evaluate and treat pain linked to joint irritation. When standard care is insufficient, image-guided orthobiologic injections may be considered to support tissue health and enhance joint function. Understanding how these injections fit into a broader cervical spine strategy is a step toward addressing the root cause of symptoms.

Understanding Cervical Facet Injections

Cervical facet joints, much like those in the knee or finger, can become painful after injury or with degenerative changes such as arthritis. Lined with cartilage, they permit controlled motion between vertebrae. These joints are supported by larger ligaments that help stabilize the neck.

When those supporting ligaments are weakened by trauma or chronic instability, the facet joints endure greater mechanical stress. Over time, cartilage may wear down, leading to the development of pain.

Each cervical facet joint refers to pain in a predictable area of the head, neck, or upper back. Upon examination, the joint may feel tender, and the pain pattern typically follows known referral patterns.^[1] Although individual experiences differ, these patterns guide targeted diagnosis and treatment:

• Base of skull or head: Likely C0–C1, C1–C2, or C2–C3.
• Central neck pain: Often C3–C4 or C4–C5.
• Upper trapezius or shoulder-blade discomfort: Commonly C5–C6 or C6–C7.

By matching joint tenderness with these maps, a clinician can pinpoint the most likely source of pain. This precision directs which cervical facet joint should receive an image-guided injection for diagnostic confirmation or therapeutic care.

Why Cervical Facet Injections Are Often Recommended

Cervical facet injections serve two key roles: diagnostic and therapeutic. The facet joints are small yet complex structures that can become sensitive due to mechanical stress, inflammation, or degeneration. In individuals with persistent neck pain, stiffness, or pain that radiates toward the head or shoulders, dysfunction in one or more facet joints is often a hidden contributor, especially when standard imaging does not reveal an obvious cause.

First, the injection helps determine whether a specific joint is the source of symptoms. A clear drop in pain after the procedure indicates that the targeted joint is involved. This confirmation guides the next steps, such as considering orthobiologic injections to support joint function and improve stability.

Second, the procedure offers a less invasive option compared to surgery and may prevent unnecessary interventions that do not address the underlying problem. When cervical instability or arthritic changes are suspected, a targeted injection can help localize and manage the irritated joint. For individuals with chronic neck pain and unclear imaging findings, the test helps clarify whether joint irritation contributes to the overall pain picture.

This focused approach is especially helpful in conditions explored in the next section. 

Conditions That May Be Addressed With Facet Injections

Cervical facet joint injections can help with spinal conditions that disturb joint function, stability, or alignment. These conditions often create mechanical stress or degeneration that irritates the facet joints and produces localized or referred pain.

By isolating and treating the affected joint, clinicians can confirm its role in the pain pattern and customize a precise treatment plan.

Osteoarthritis

Cervical facet osteoarthritis, also called degenerative facet arthropathy, develops when cartilage inside the facet joint slowly wears away. Aging, repetitive stress, or prior injury can speed up this process. As cartilage thins, exposed bone surfaces may become inflamed, leading to stiffness, reduced motion, and pain that can radiate to the head, shoulders, or upper back.

Image-guided facet injections help determine whether an arthritic joint is producing these symptoms. If pain eases after the injection, joint involvement is confirmed, and treatment can be customized. In some cases, the injection provides short-term relief while additional options, such as orthobiologic procedures, are considered to support joint function.

Spinal Trauma

Trauma such as whiplash, falls, or high-impact collisions can place sudden force on the cervical facet joints and nearby ligaments. Even when imaging reveals no fracture or significant disc injury, micro-instability or joint irritation may still develop. These subtle changes can lead to persistent neck pain, muscle tightness, and reduced motion long after the initial event.

Image-guided facet injections help confirm whether a specific joint is driving post-traumatic symptoms. Identifying the source of pain supports a targeted plan of care. In selected cases, orthobiologic solutions are introduced during the injection to promote tissue repair and improve joint stability, especially when ligaments or joint capsules are strained rather than torn.

Spondylolisthesis

Cervical spondylolisthesis occurs when one vertebra slips forward relative to the one below it. This shift places extra stress on the facet joints, especially when supporting ligaments are weak or when degeneration is present. The added load can create joint irritation, inflammation, and pain during neck movement or prolonged positioning.

Image-guided facet injections help determine whether the slipped segment is a source of pain. When spondylolisthesis produces mechanical stress on a facet joint, a targeted injection can confirm joint involvement and guide care. 

Degenerative Disc Disease

Degenerative disc disease in the cervical spine refers to the gradual breakdown of intervertebral discs. As discs lose height and hydration, they cushion less, and more mechanical load shifts to the facet joints.^[2] This added stress can speed joint wear and trigger irritation or inflammation.

When neck pain accompanies disc degeneration, it can be challenging to determine whether the symptoms originate from the disc, the facet joint, or both. An image-guided facet injection helps isolate the pain source. If the joint proves to be involved, orthobiologic options may be added to support joint function and lessen the secondary effects of disc collapse.

Ankylosing Spondylitis

Ankylosing spondylitis is a chronic inflammatory disorder that mainly affects the spine and sacroiliac joints. Ongoing inflammation—even in the cervical facet joints—can lead to stiffness, reduced mobility, and, in advanced stages, joint fusion. The condition typically begins in the lower spine but may spread to the neck as it progresses.

When cervical facet inflammation is suspected, an image-guided injection can help confirm which joint is contributing to the pain or motion loss. Although ankylosing spondylitis is a systemic condition, targeted facet injections may alleviate local symptoms when a specific joint is markedly affected. This local care complements broader medical strategies aimed at controlling inflammation and slowing the progression of the disease.

• Annular Tear: An annular tear is a small rupture in the outer layer of a spinal disc, which may cause localized back pain or nerve irritation. Symptoms can vary, with some tears leading to radiating pain, numbness, or weakness if the disc presses on nearby nerves. Read More About Annular Tears.
• Bulging Disc: A bulging disc occurs when a spinal disc extends beyond its normal space without rupturing. Depending on the affected area, it may cause localized pain or nerve compression, leading to numbness, tingling, or weakness in the back, neck, or limbs. Read More About Bulging Discs.
• Spinal Stenosis: Spinal stenosis is when the spinal canal narrows, putting pressure on the spinal cord or nerves. It may cause pain, numbness, tingling, or weakness in the back, legs, or arms, often worsening with prolonged standing or walking. Read More About Spinal Stenosis.
• Torn Disc: A torn disc, or annular tear, occurs when the outer layer of a spinal disc is damaged, potentially causing pain, inflammation, or nerve irritation. Symptoms may include localized back pain or radiating discomfort if the tear affects nearby nerves. Read More About Torn Discs.

• Torn Disc: A torn disc, or annular tear, occurs when the outer layer of a spinal disc is damaged, potentially causing pain, inflammation, or nerve irritation. Symptoms may include localized back pain or radiating discomfort if the tear affects nearby nerves.

How Facet Injections For Neck Pain Are Performed

Facet injections in the cervical spine are precision-guided procedures that target joints suspected of causing pain. Care begins with a clinical evaluation that reviews symptoms, physical findings, and known referral patterns to select the likely pain-generating joint.

The injection is carried out under real-time imaging, most often using fluoroscopy—live X-ray imaging—or, in some cases, ultrasound. Imaging confirms accurate needle placement within the small joint space or next to the sensory nerve branch that supplies it. Once the position is verified, a small volume of medication—typically a local anesthetic, sometimes combined with an anti-inflammatory agent or orthobiologic solution—is delivered.

The aim can be diagnostic, therapeutic, or both. A diagnostic injection measures pain relief to confirm whether the joint is the source of symptoms. A therapeutic injection, particularly one that incorporates orthobiologics, aims to support joint health and alleviate inflammation over time.

The procedure is brief and usually performed in an outpatient suite. Most individuals resume normal activity on the same day, although mild soreness at the injection site may occur. The pain response guides the next steps, such as addressing structural instability, adding orthobiologic support, or focusing on rehabilitation.

Studies That Show How This Treatment Can Help

A recent case series evaluated orthobiologics for cervical facet–related neck pain using a functional spinal unit (FSU) model.^[3] In this approach, clinicians treated the motion segment as a whole—facet joints, supporting ligaments, and, when indicated, the nearby epidural space—rather than focusing on a single “pain generator.” 

Using live X-ray guidance (fluoroscopy), platelet-rich plasma (PRP) and platelet lysate (PL) prepared from each patient’s own blood were placed into the targeted structures. Targets were selected based on symptoms, exam findings, and MRI. Fourteen adults with axial neck pain, with or without radiating symptoms, met the study criteria and were followed for 24 months.

Results were tracked with the Numeric Pain Score (NPS, 0–10) and the Functional Rating Index (FRI, 0–100). At 24 months, average pain was reduced by 2.8 points on the NPS, meeting the study’s threshold for meaningful change. Function showed an average improvement of 27.3 points on the FRI. 

A global self-rating, the Single Assessment Numeric Evaluation (SANE), indicated an average 64% improvement at 24 months. Two patients did not show improvement. Reported side effects were mild and temporary, such as short-lived itching or a brief skin rash.

The authors note key limitations: this was a small registry without a control group, treatment details varied by patient, and some received more than one session. Even with those caveats, this case series suggests that carefully targeted, image-guided orthobiologic injections—addressing facet joints, stabilizing ligaments, and the nearby nerve environment—may help reduce neck pain and improve function for some patients.

Traditional Vs. Orthobiologic Options For Facet Joint Pain

Two distinct strategies exist for treating cervical facet joint pain: traditional pain management and orthobiologic-based care. Each path has its own goals, methods, and long-term effects. Traditional care centers on reducing symptoms, often through medications or nerve-targeted procedures. Orthobiologic care aims to support joint tissues and address underlying instability or degeneration of the joints.

The summary below outlines the key points for both options, including benefits and limits. A short video at the end of this section provides added context for readers new to orthobiologic treatments.

Traditional Pain Management

Traditional pain management aims to reduce or interrupt pain signals from an affected facet joint. Care often begins with high-dose corticosteroid injections into the joint or with medial branch blocks that numb the small nerve branch responsible for carrying pain signals. If relief is short-lived, treatment may progress to radiofrequency ablation (RFA), which uses heat to deactivate the sensory nerve fibers.

RFA can reduce pain for several months, but it may not address joint degeneration or instability. Many individuals require repeat ablations. 

Orthobiologic

Orthobiologic care takes a different approach by aiming to support tissue repair and slow the progression of ongoing degeneration. PRP delivers concentrated growth factors to an irritated or arthritic facet joint. In some cases, bone marrow concentrate (BMC) containing the individual’s own healing agents is added to enhance joint recovery and health.

Treatment often extends to nearby stabilizing structures, such as ligaments, that influence facet-joint loading and wear. By addressing both the joint and its support system, orthobiologic care seeks to improve stability and long-term function, rather than simply reducing pain signals.

For a concise overview of how orthobiologics work in spinal joints, see the video below.

How To Identify Proper Vs. Incorrect Facet Joint Injections

Precision matters when treating cervical facet joint pain. Not every procedure labeled a “facet joint injection” places medication inside the joint space. Because these joints are small and hard to reach, proper technique demands advanced training, specialized equipment, and consistent experience.

A true facet injection uses live imaging—fluoroscopy or ultrasound—to guide the needle into the joint. Contrast dye then confirms accurate placement. Anything less risks missing the joint and delivering an ineffective treatment.

Understanding this difference protects against unnecessary procedures and avoidable risk. When an injection is performed under image guidance by a physician with interventional spine or orthopedic expertise, care may be informed and research-based.

Real Facet Joint Injection

A true cervical facet joint injection places the needle directly into the joint under continuous imaging, most often using fluoroscopy—live X-ray imaging. Once the tip appears inside the joint, contrast dye is injected to confirm its position. This step, called an arthrogram, offers visual proof that the medication will reach the intended space.

Such precision demands advanced training. Most physicians who perform accurate facet injections have completed an interventional spine fellowship and regularly carry out these procedures. Due to the technical details involved, each joint typically takes several minutes to access and verify.

Fake Facet Injections 

A “fake” facet joint injection places the needle near, but not inside, the joint. The clinician may rely only on anatomical landmarks or basic imaging and skip the use of contrast dye. Without that confirmation, there is no proof that medication reaches the joint space, and the procedure has limited diagnostic or therapeutic value. Because the technique is quick—often completed in seconds—it falls short of the accuracy required for true joint targeting.

Some treatments, such as prolotherapy, are occasionally described as facet injections. Prolotherapy involves injecting an irritant solution near ligaments or soft tissues in order to stimulate repair. While it may help support structures, it does not reliably enter the joint unless performed with imaging and contrast. Mislabeling these procedures can create confusion and lead patients to believe the joint has been treated when, in fact, it has not.

Accuracy becomes critical at the upper cervical levels, specifically C0–C1 and C1–C2. These joints are situated near the vertebral artery, a major blood vessel that supplies the brain. 

Safe injection at these levels demands precise fluoroscopic guidance and, in many cases, digital subtraction angiography. This technique uses a computer to remove the bone and soft tissue from the real-time X-ray image, leaving a clear view of the blood vessels. This allows the physician to confirm that the needle is not inside a blood vessel before injecting any medication.

Because the joints are rarely treated, even by experienced specialists, they should be injected only by physicians who perform the procedure frequently and use appropriate safeguards.

Can Treating Facet Joints Alone Relieve Neck Instability?

Treating a painful cervical facet joint in isolation may help ease localized pain. However, it does not address mechanical neck instability when ligament injury is present. While facet joints are vulnerable to degeneration, they are not the spine’s primary stabilizers. 

Stability in the upper cervical spine (C0–C2) relies heavily on the alar, transverse, and accessory ligaments, which help guide motion between the skull and the top two vertebrae. In the mid- and lower cervical spine, larger stabilizing ligaments such as the supraspinous, interspinous, and intertransverse ligaments also play a central role in controlling motion.

If these ligaments become lax or damaged, abnormal movement can occur between vertebrae. Extra motion may overload the facet joints, contributing to inflammation, cartilage loss, and pain. Injecting an orthobiologic into the joint may support repair or slow wear; however, this primarily addresses the consequence—not the underlying cause—of instability.

For longer-term improvement, supportive ligament structures often need to be addressed as well. When both ligament laxity and joint wear are present, combining joint- and ligament-focused care may provide a more comprehensive approach to help reduce pain and limit abnormal motion.

It is also important to distinguish pain from instability-driven symptoms. For example, if repositioning the C0–C1 joint quickly relieves headaches or autonomic symptoms, the worn joint surface itself is unlikely to be the source, since surface wear would persist even after realignment. Instead, rapid relief may point to irritation of joint-capsule proprioceptors, occipital nerves, or the nearby vagus nerve. In such cases, symptoms are more likely linked to disrupted neural signaling from instability rather than cartilage loss within the joint.

The Regenexx Targeted Approach For Facet Joint Relief 

The Regenexx approach is rooted in interventional orthobiologics, a field that uses image-guided procedures to help support tissue recovery and may help improve joint or spinal function. Rather than focusing only on masking symptoms, procedures using Regenexx injectates are designed to address underlying contributors to pain.

A key feature of this approach is the use of advanced imaging techniques, such as fluoroscopy (live X-ray) or ultrasound, to guide needle placement with precision. Accurate placement allows delivery of orthobiologic injectates, such as PRP or BMC, which are prepared from the individual’s own healing agents, into the joint or its supporting structures.

Regenexx orthobiologics are prepared using proprietary processing methods, rather than standard bedside centrifuges. This approach may allow greater consistency and flexibility in preparing injectates for use in procedures. For example, the Regenexx SCP injectate is a specialized preparation that differs from standard PRP, allowing physicians in the licensed Regenexx network to select a formulation that may best match the needs of a particular joint or surrounding tissues.

Precise targeting, combined with customized biologics, may help to reduce pain and improve function. Overall, this approach offers a thorough method for managing cervical facet joint pain.

Discover How Regenexx May Support Cervical Spine Stability

Understanding the difference between facet-joint pain and cervical instability helps guide the right treatment plan. Targeted orthobiologic injections may alleviate an irritated facet joint; however, supporting spinal stability often requires care for the ligaments that control vertebral motion.

The Regenexx approach addresses both needs. Image-guided injections deliver customized biologics to the painful joint while also supporting the ligaments that keep the cervical spine aligned. This dual focus, precise guidance, customized biologics, and root-cause correction, creates a comprehensive path for individuals with complex neck pain conditions.

A clear understanding of how joints, ligaments, nerves, and imaging interact empowers informed decisions.

Explore all your options to make an informed decision. Consult a physician in the licensed Regenexx network to learn more.

Medically Reviewed By:

Dr. Chaz Fausel, MD

Dr. Chaz Fausel is a Denver-based interventional orthopedics specialist and Regenexx educator, trained at Emory and the Centeno-Schultz Clinic.