Facet Joint Injections in Dubai: Neck and Lower Back
Who you'll see
Dr Sherief Elsayed
Consultant Spinal Surgeon, FRCS (Tr & Orth), UK-trained
Facet joint injections, medial branch blocks and radiofrequency denervation (RFA) are used for neck or lower back pain that comes from the small joints at the back of the spine. They are related but not the same: one is mainly a test to find the source of pain, another treats it for longer. This page explains the difference, who may benefit, the day itself, the risks and the evidence.
Dr Sherief Elsayed performs cervical (neck) and lumbar (lower back) facet joint injections, medial branch blocks and radiofrequency denervation himself at American Hospital Dubai.
At a glance
- What: X-ray-guided injections into the facet joints, or onto the nerves that supply them, and RFA of those nerves.
- For: pain felt mainly in the spine, not mainly down an arm or leg.
- Where: American Hospital Dubai, with X-ray (fluoroscopy) guidance.
- Anaesthetic: local anaesthetic; light sedation on request, but not for test blocks.
- Going home: the same day; someone else drives you, as you should not drive that day.
What are the facet joints?
Each level of the spine has two facet joints, one on each side at the back, linking one vertebra to the next. As Dr Elsayed puts it: “Facet joints are at the back of the spine. They are what move when you bend backwards and when you bend forwards. They run all the way up to your neck.”
Like knees and hips, facet joints are lined with cartilage. They can wear with age, become inflamed, or be strained by an injury such as whiplash. Small nerves called medial branches carry pain signals from each joint, and these nerves are the target of a medial branch block and of RFA.
What does facet joint pain feel like?
- a deep ache in the neck or lower back, on one or both sides;
- pain that is worse leaning backwards, looking up or twisting, and eases bending forwards (see why leaning backwards can make back pain worse);
- stiffness after rest, such as first thing in the morning or after a long drive;
- an ache spreading into the buttock or thigh, or from the neck towards the shoulder blade or the back of the head, without the sharp, electric quality of nerve pain.
No sign in the history or examination reliably predicts who will respond to a facet block (Cohen 2020), and facet wear often shows on scans of people with no pain. That is why a test block is used.
Who facet joint injections may help
Facet procedures may be worth considering if:
- your pain is mainly in the neck or lower back, and examination points to the facet joints;
- pain has continued despite physiotherapy, exercise, medicines and activity changes. Guidelines suggest about three months of this for the lower back (Cohen 2020) and around six weeks for the neck (Hurley 2022);
- neck pain after a whiplash injury has not settled.
If your main problem is leg pain from a trapped nerve in the lower back, an epidural or nerve root injection is usually more appropriate; see spinal injections in Dubai. For arm pain from a trapped nerve in the neck, treatment usually starts with non-surgical care, with surgery considered if needed.
When a facet procedure may not be suitable
An injection may need to be delayed, changed or avoided if you have:
- an infection, at the injection site or elsewhere in the body;
- a bleeding disorder, or you take a blood thinner. The plan is decided case by case and agreed with the doctor who prescribes it; never stop a blood thinner on your own. For medial branch blocks and RFA, guidelines say many people can continue these medicines (Cohen 2020);
- a pregnancy, or a chance of one: X-ray-guided injections are usually avoided in pregnancy;
- an allergy to local anaesthetic, contrast dye or steroid;
- diabetes: tell us, because the injection may be postponed if your blood sugar control is poor;
- a pacemaker, defibrillator, spinal cord stimulator or other implant, which needs planning with your device team before RFA (Cohen 2020);
- warning signs of another cause (listed below), which need investigating first.
Joint injection or medial branch block: what is the difference?
Intra-articular facet joint injection
A fine needle is placed inside the joint and a small volume of local anaesthetic with a steroid is injected. It can show whether that joint is the source of pain, and the steroid may settle an inflamed joint for a time. Guidelines see a role for it in particular cases, such as younger people with an inflamed joint or people for whom RFA is unsuitable, but not as a routine repeated treatment (Cohen 2020; Hurley 2022).
Medial branch block
Here the needle stays outside the joint. Local anaesthetic only, with no steroid, is placed on the medial branch nerves, usually two for each joint, because each joint has a double nerve supply. If your usual pain eases substantially while the anaesthetic works, those nerves carry your pain. Guidelines prefer this block as the test before RFA, because it predicts the RFA result better (Cohen 2020; Hurley 2022).
Test or treatment?
| Joint injection | Medial branch block | Radiofrequency denervation | |
|---|---|---|---|
| Where | Inside the joint | On the nerves to the joint | On the nerves to the joint |
| What is used | Local anaesthetic and a steroid | Local anaesthetic only | A controlled radiofrequency current |
| Main purpose | Test and short-term treatment | Test before RFA | Treatment |
| How long the effect lasts | Varies, usually temporary | While the anaesthetic works | Longer, but not permanent (see below) |
The pathway: test block first, then radiofrequency denervation
Dr Elsayed uses a stepped approach, starting with the least invasive option:
- Assessment: history, examination and, where needed, scans to rule out other causes.
- Non-surgical care: physiotherapy, exercise, medicines and activity changes.
- Test: if pain persists, a medial branch block (or sometimes a joint injection) at the suspected levels.
- Treatment: if the test clearly relieves your usual pain, RFA of the same nerves.
- Rehabilitation: physiotherapy afterwards, to build strength while pain is lower.
In his words: “If that gets rid of your pain, we know that’s where the pain is coming from.”
What counts as a positive test?
Before the block you rate your usual pain. Afterwards you try the movements that normally hurt and record your pain over the following hours. International guidelines count relief of about half or more of your usual pain (a 50% threshold) as positive, and say that one positive block is usually enough before RFA (Cohen 2020; Hurley 2022).
If the block does not help, that is useful too: the pain probably comes from elsewhere, such as a disc or the sacroiliac joint, and you avoid an RFA that would be unlikely to work.
Radiofrequency denervation (RFA)
RFA follows the same route as the test block, using an insulated needle. Once the tip is beside the nerve, a mild electrical test may check its position, the area is numbed, and a controlled current heats the tip to disrupt the nerve. As Dr Elsayed describes it, the needle “disrupts its nerve supply. So it stops sending pain signals up to the brain.” The joint itself is not changed. More detail: radiofrequency denervation for facet joint pain.
How long relief lasts, and repeat treatment
Relief from RFA usually starts within 1 to 3 weeks. It is not permanent, because the nerves gradually regrow. In studies of neck RFA, the median time before pain returned ranged from 6 to 14 months (Hurley 2022).
If pain returns after a good response, RFA can be repeated. Guidelines suggest repeating it when the last treatment gave at least 3, and preferably 6, months of benefit, no more than twice a year, and usually without a new test block (Cohen 2020). Steroid injections into the joint are spaced out and limited, and decided case by case.
Neck and lower back: what is different
Dr Elsayed uses X-ray (fluoroscopy) guidance for these procedures in both regions.
- Neck: guidelines recommend X-ray (fluoroscopy) or ultrasound guidance for blocks and X-ray guidance for RFA, and advise against RFA on both sides of the neck in one session (Hurley 2022). Treating the highest neck facet joint (C2 to C3), a cause of headache at the back of the head, more often brings temporary numbness, altered skin sensation or unsteadiness afterwards (Hurley 2022).
- Lower back: guidelines recommend X-ray or CT guidance, with ultrasound in some situations (Cohen 2020).
Which levels and sides are treated in one session is decided at your consultation.
What happens on the day
- You arrive at American Hospital Dubai. Your medicines, allergies and consent are checked.
- You lie on the procedure table in the position that suits your procedure; this is explained beforehand.
- The skin is cleaned and numbed with local anaesthetic.
- Using X-ray (fluoroscopy) guidance, Dr Elsayed guides a fine needle to the joint or the nerves. A little contrast dye may confirm the position.
- The local anaesthetic (with a steroid, for a joint injection) is injected or, for RFA, the nerve is tested and treated.
- You rest for a short time before going home. After a test block, you try the movements that usually hurt and record your pain over the following hours.
You are awake, with local anaesthetic. Light sedation is available on request for joint injections and RFA, but never for a diagnostic test block: guidelines advise against routine sedation for test blocks, because it can make the result harder to interpret (Cohen 2020; Hurley 2022). Someone else needs to drive you home.
Aftercare
- Soreness where the needle went in usually settles within a few days.
- After RFA, pain, a burning feeling or patches of numb skin are common for a few days to a few weeks, and after neck RFA some people feel dizzy or unsteady for a while (Cohen 2020; Hurley 2022).
- Simple painkillers may help. The aftercare for your procedure is explained before you go home.
- If you have diabetes and a steroid was used, check your blood sugar more often for a few days.
- Driving: do not drive on the day of the procedure; someone else should drive you home. Work and normal activities: when to return is decided at your consultation. Follow-up: arranged at your consultation.
- Physiotherapy: start or continue as advised. RFA does not treat the wear in the joint, so building strength and changing the habits that provoke pain are part of the treatment.
Risks and side effects
Serious complications are uncommon when these procedures are done with image guidance; a systematic review of neck RFA reported only minor, temporary side effects (Hurley 2022). Possible effects:
- Common and temporary: soreness and a short flare of pain; after RFA, the effects listed under Aftercare (Cohen 2020; Hurley 2022).
- Less common: bruising or bleeding; feeling faint; with a steroid, flushing, disturbed sleep or a rise in blood sugar; an allergic reaction.
- Rare: infection; injury to a nearby spinal nerve, which image-guided positioning aims to prevent. RFA also affects small muscles beside the spine that share the same nerves; the long-term significance is unclear (Cohen 2020).
What the evidence says
Facet procedures are widely used, but the research is mixed:
- International guidelines for the lower back (Cohen 2020) and the neck (Hurley 2022), agreed by multiple specialist societies, conclude that RFA may benefit well-selected people, and that the medial branch block is the better test for selecting them.
- NICE (the UK National Institute for Health and Care Excellence) supports considering RFA for moderate or severe chronic low back pain from the facet joints when non-surgical treatment has not worked, after a positive medial branch block (NICE NG59).
- A Cochrane review rated the overall evidence for RFA in chronic low back pain as very low to moderate quality, with no high-quality trials (Maas 2015).
- The MINT trials in the Netherlands found that adding RFA to a 3-month exercise programme gave no clinically important extra improvement in pain at 3 months for facet joint pain (Juch 2017).
In practice: careful selection, a positive test block before RFA, exercise alongside it, and realistic expectations.
Alternatives to facet injections
- Physiotherapy and exercise to strengthen the muscles that support the spine. For some people this is enough.
- Medicines: simple painkillers and, where suitable, anti-inflammatories for flare-ups (see medication).
- Activity changes: breaks during long drives and desk work, and adjusting extension-heavy gym exercises such as overhead pressing.
- Surgery is not usually needed for facet pain alone. It may be considered when facet wear is part of a wider problem, such as spondylolisthesis or spinal stenosis.
When to seek urgent care
Call 998 (UAE ambulance) or go to the nearest emergency department if you have back or neck pain with any of these:
- new difficulty passing urine, or loss of bladder or bowel control;
- numbness between the legs or around the back passage (cauda equina syndrome);
- weakness in the legs or arms that is getting worse, clumsy hands or unsteady walking;
- fever, unexplained weight loss, or a history of cancer, with new spinal pain;
- after an injection: fever, redness or discharge at the injection site, a severe headache, or new weakness that does not wear off as the local anaesthetic fades.
Fees and insurance
Fees depend on the procedure and your insurance; OrthoPro reception can check your cover and any pre-approval.
Table of Contents
Your consultation with Dr Sherief Elsayed
Dr Sherief Elsayed is a UK-trained Consultant Spinal Surgeon, FRCS (Tr & Orth). He performs these procedures himself and also treats spinal conditions surgically, so he can discuss non-surgical and surgical options in one consultation. After examining you and reviewing your scans, he will explain whether the facet joints are a likely source and whether a test block makes sense.
Please bring your scans and reports, a list of your medicines (including blood thinners), and details of any previous injections and how much they helped.
He sees patients at OrthoPro Clinic, Dubai Science Park, and at UPANDRUNNING on Al Wasl Road. To book, call OrthoPro Clinic on 04 835 9000, send a WhatsApp message to 052 105 2798, or request an appointment.
Medically reviewed by Dr Sherief Elsayed, UK-trained Consultant Spinal Surgeon, FRCS (Tr & Orth). Last reviewed 14 October 2026.
Frequently asked questions
A facet joint injection puts local anaesthetic and a steroid inside the joint. A medial branch block puts local anaesthetic only on the small nerves that carry pain from the joint. Both can show whether the joint is the source of pain. Guidelines prefer the medial branch block as the test before radiofrequency denervation, because it predicts the result better.
The skin is numbed first. You may feel pressure and brief discomfort while the needle is positioned. Soreness at the injection site for a few days afterwards is common. Light sedation is available on request, but not for a diagnostic test block.
It depends on the type. A medial branch block is a test, so its effect lasts only while the local anaesthetic works. A steroid injection into the joint may ease pain for a variable time. Radiofrequency denervation usually starts to work within 1 to 3 weeks and lasts longer, but it is not permanent: in neck studies the median time before pain returned was 6 to 14 months (Hurley 2022).
Then the facet joints are probably not the main source of your pain, and radiofrequency denervation would be unlikely to help. Dr Elsayed will look at other possible sources, such as a disc, a nerve root or the sacroiliac joint, and discuss other treatment.
No. Radiofrequency denervation uses a controlled current to disrupt the medial branch nerves so that they stop carrying pain signals from the joint. It is offered only after a positive medial branch block, and it can be repeated if pain returns after a good response.
Yes, in some cases. Guidelines suggest repeating radiofrequency denervation if the previous treatment gave at least 3, and preferably 6, months of benefit, and no more than twice a year (Cohen 2020). Steroid injections into the joints are spaced out and limited, and decided case by case.
You should not drive on the day of the procedure, so please arrange for someone else to drive you home. When you can return to work and normal activities depends on your work and the procedure, and is decided at your consultation.
Not usually. Facet joint pain is felt mainly in the back or neck. Leg pain from an irritated nerve is more often treated with an epidural or a nerve root injection; see spinal injections in Dubai. Badly worn facet joints can narrow the space around a nerve, but that is treated as nerve compression.