If i have facet joint injections and they work short term what next? how bad do you have to be to get surgery?

Depends: It depends on how well they work and how long it lasts between injections. If you can go months, then surgery not close. If it helps for a few days, then a good spine surgeon you need to meet.

If you get relief: From facet joint injections then you can have another injection called a medial branch block , which if the same relief is provided, then you would be a candidate for radio frequency lesioning or rhizotomy for longer term relief. Surgery is reserved for those who fail comprehensive non op rx and have a surgical indication ie.: something that can have a reasonable degree of good surgical outcome.