The spine is the most common cause of chronic back pain. It can cause significant loss of function or disruption in activity of daily living and is extremely common in the elderly. Of the various causes of spinal pain, facet joint syndrome is often a diagnosis of exclusion, as it is difficult to differentiate the latter from pain secondary to degenerative disk disease or spinal stenosis because of overlapping clinical features and poor correlation between the clinical presentation and the imaging abnormalities. Further, localizing the source of pain is challenging as facet joint disease may not be limited to only 1 joint. Pain arising from the facet joints can be attributed to segmental instability, synovitis, synovial entrapment, trauma, meniscoid impingement, chondromalacia, and osteoarthritis. Facet joint injection is performed under fluoroscopy or computed tomography guidance, which facilitates accurate needle placement while reducing potential injury to the surrounding vital structures. Indications of facet joint injection include clinical suspicion of facet joint syndrome, chronic pain not relieved by trial of nonsteroidal anti-inflammatory drugs and physiotherapy, patients with confirmed facet joint syndrome, presence of adjacent segment deterioration after spinal fusion or persistent low back pain after a stable posterolateral fusion, and patients in whom oral or systemic drug therapy have to be withdrawn because of adverse effect or have exceeded the maximum tolerable dose. Given the high success rate and low complications, image-guided facet injection is deemed safer and more effective compared with conventional “blind” injections.