Facet disease, also known as facet joint syndrome or facet arthropathy, is the degeneration and inflammation of the small paired joints (facet joints) located at the back of each vertebra. These joints guide and limit spinal movement, and their deterioration is a common source of chronic neck and back pain.
Facet disease rarely occurs in isolation — it is closely intertwined with other degenerative spinal conditions. It frequently develops alongside Degenerative Disc Disease, as disc height loss shifts increased load onto the facet joints. Facet hypertrophy is also one of the leading contributors to Spinal Stenosis and Foraminal Stenosis, and the associated instability can promote Synovial Cysts within the facet joint capsule.
Causes
Age-related degeneration.
Like other joints in the body, facet joints are lined with cartilage and surrounded by a synovial capsule. Over time, repetitive stress, disc degeneration, and normal aging cause the cartilage to break down, leading to bone-on-bone contact, inflammation, and the development of bone spurs (osteophytes).
Other causes
Prior spinal injury, poor posture, obesity, and certain occupational activities involving repetitive bending, twisting, or heavy lifting can accelerate facet joint degeneration. Inflammatory arthritis conditions can also affect the facet joints.
Symptoms
Facet disease typically causes localized pain on one or both sides of the spine that may radiate into the buttocks, hips, or thighs (lumbar facets) or into the shoulder and arm (cervical facets). Pain is often worsened by spinal extension, rotation, or prolonged standing, and is relieved by leaning forward or sitting. Morning stiffness and pain after periods of inactivity are also common. Unlike disc-related nerve compression, facet pain rarely produces true radicular symptoms extending below the knee.
Diagnosis
A thorough physical examination identifies characteristic patterns of pain reproduction with extension and rotation. X-rays may show joint space narrowing, osteophyte formation, and sclerosis around the facet joints.
A cervical or lumbar spine MRI and CT scan provide more detailed assessment of cartilage loss, joint hypertrophy, and any associated nerve root or spinal canal compromise. Diagnostic medial branch nerve blocks — injecting a small amount of local anesthetic near the nerves supplying the facet joints — are the gold standard for confirming that a particular joint is the pain generator.
Degeneration Grading
Facet joint degeneration is graded on imaging based on the extent of structural changes.
- Grade 0: Normal facet joint with no degeneration.
- Grade 1: Mild narrowing of the joint space and small osteophytes.
- Grade 2: Moderate narrowing, erosions, and moderate osteophyte formation.
- Grade 3: Severe narrowing, large osteophytes, subchondral cysts, and severe hypertrophy.
Treatments
Treatment is aimed at reducing pain and restoring function. A stepwise approach beginning with the least invasive options is typically recommended.
Conservative measures including activity modification, physical therapy, NSAIDs, and muscle relaxants are the first line of treatment. Weight loss and postural correction can reduce mechanical stress on the facet joints over time.
Interventional treatment: Facet joint steroid injections or medial branch nerve blocks can provide diagnostic confirmation and significant pain relief. For patients who experience temporary but repeatable relief from nerve blocks, radiofrequency ablation (RFA) — a procedure that uses heat to disrupt the pain-transmitting nerves — can provide longer-lasting relief lasting 6–18 months or more.
Surgical treatment
Surgery is rarely needed for facet disease alone. However, when significant facet hypertrophy contributes to spinal stenosis causing neurological compromise, surgical decompression (laminectomy) or fusion may be indicated.
Related Spine Conditions
- Degenerative Disc Disease
- Spinal Stenosis
- Foraminal Stenosis
- Synovial Cysts
- Spondylolisthesis
- Back to all Spine Conditions
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