BlueCross BlueShield of Tennessee Medical Policy Manual

Lumbar Facet Steroid Injections for Treatment of Low Back Pain


Lumbar facet injections for the treatment of low back pain involve a steroid medication being injected into the facet joint (intra-articular) or around the nerve supply to the facet joint (medial branch block) of the lumbar spine. The diagnostic objective is to help determine the origin of the low back pain. The therapeutic objective is temporary relief of low back pain unresponsive to conservative treatment (e.g., oral medications, rest/limited activity, and/or physical therapy). These techniques use fluoroscopy visualization for needle placement. The procedure is performed in the outpatient setting.

The scientific literature does not reveal a consensus of definition for acute and chronic low back pain. The following definitions will be used for the purpose of this policy:

It is also recognized that acute exacerbations or new acute episodes may be superimposed on otherwise chronic conditions.


See also:  MCG Care Guideline - Facet Neurotomy

Policies with similar titles: Lumbar Epidural Steroid Injections for Treatment of Low Back Pain




In order to minimize the risks from large doses of steroids, more than 4 (four) injection sessions within a 12-month period is not generally appropriate.


BlueCross BlueShield of Tennessee network physicians. September 2001.

Heran, M., Smith, A. D., & Legiehn, G. M. (2008). Spinal injection procedures: A review of concepts, controversies, and complications. Radiologic Clinics of North America, 46 (3), 487-514.

Manchikanti, L., Boswell, M., Singh, V., Benyamin, R., Fellows, B., Abdi, S., et al. (2009) Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician, 12 (4), 699-802.

Manchikanti, L., Manchikanti, K. N., Manchukonda, R., Cash, K. A., Damron, K. S., Pampati, V., et al. (2007). Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: Preliminary report of a randomized, double-blind controlled trial: Clinical Trial NCT00355914. Pain Physician, 10 (3), 425-440. (Level 1 Evidence - Independent study)

Manchikanti, L., Singh, V., Falco, F. J., Cash, K. A., & Pampati, V. (2008). Lumbar facet joint nerve blocks in managing chronic facet joint pain: One-year follow-up of a randomized, double-blind controlled trial: Clinical Trial NCT00355914. Pain Physician, 11 (2), 121-132. (Level 1 Evidence - Independent study)

Peh, W. (2011). Image-guided facet joint injection. Biomedical Imaging and Intervention Journal, 7 (1).

Practice guidelines for chronic pain management: An updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. (2010). Anesthesiology, 112 (4), 810-833.

Winifred S. Hayes. Medical Technology Directory. (2006, October, last updated search October 2010). Facet blocks for chronic back pain. Retrieved October 31, 2011 from (48 articles and/or guidelines reviewed)

Work Loss Data Institute. (2008). Low back - lumbar & thoracic (acute & chronic). Retrieved October 31, 2011 from




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