Facet Arthropathy

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What is a facet joint?

Facet joints are small joints that link the individual bones of the spine together. They are located at the posterior aspect (rear) of the spine and are involved in bending, twisting, and leaning. They are true synovial joints (meaning, they each have a joint capsule just as the hip or knee does) and can develop arthritis like the other joints of the body.

What is facet arthropathy?

Facet arthropathy is arthritis of the facet joints. This can also be thought of as degenerative changes of the facet joints.

What causes facet arthropathy?

The most common cause is degeneration of the facet joints, which occurs as we age. This is known as facet arthrosis or osteoarthritis of the facet joint, and it is one of the most common causes of lower back pain, although it can affect the upper back or neck as well.

Types of facet arthropathy

• facet joint arthrosis – chronic degenerative changes to the facet joints
• facet joint hypertrophy –  enlargement of the facet joints
• joint effusion/inflammation – fluid or swelling in the facet joints
• instability or subluxation – movement outside of the normal location of the facet joint
• synovial cysts – small fluid-filled protrusions from the facet joints. These occur when the fluid from the synovium of a facet joint bulges outwards, forming a cyst
• inflammatory arthritis (erosion or ankylosis) – medical conditions that can target the facet joints specifically

What symptoms does facet arthropathy cause?

Facet arthropathy usually causes back or neck pain without causing pain to radiate into the legs or arms. This pain is generally aching, throbbing, and sharp. It is usually worse with extending the neck or back, like when looking backwards over a shoulder or twisting at the hips.

What is facet joint syndrome?

Facet joint syndrome is the pain condition caused by facet arthropathy. Whereas facet arthropathy is the cause and what the physician diagnoses based on physical exam and imaging, facet joint syndrome is the collection of symptoms that the patient feels. Facet joint syndrome is aching, throbbing, sharp pain felt typically in the low back that is worse with bending and twisting.

Who is at risk for facet arthropathy?

Facet arthropathy can happen to anyone. It is more common as people age because it is a degenerative process like arthritis, but it can also happen when the spine has repeated stress or injuries. This can happen in people with physically active jobs, after an injury, from poor posture, in scoliosis, or with obesity.

How is facet arthropathy diagnosed?

Facet arthropathy is diagnosed based on the description of pain, physical exam, and imaging studies. When facet arthropathy is suspected, diagnostic injections (medial branch blocks) can be used to confirm the diagnosis.

Do facet joint problems show up on an MRI?

Yes, facet joint changes and problems can be seen on an MRI. The size of the joint can increase, the shape of the joint can change, and fluid can often be seen within the joint.

Can facet arthropathy get better without treatment?

Facet arthropathy generally does not get better without treatment because it is due to degeneration in the spine. But, similar to arthritis in other joints of the body, facet arthropathy can cause pain flares that resolve spontaneously. If the pain from facet arthropathy becomes more frequent or severe, seeing a physician for evaluation and a treatment plan is best.

Is walking good for facet arthropathy?

Yes, walking is good for facet arthropathy. Walking maintains joint health, supportive muscle strength, and physical function. 

What should I not to do if I have facet arthropathy?

Activities that provoke pain should be avoided. These include lifting heavy objects, twisting and rotating, and leaning backwards. Lifting heavy weights, high-rotation motions like swinging, and combining bending over and twisting can place strain on the facet joints and increase pain.

What aggravates facet joint pain?

Facet joint pain is aggravated with placing weight and strain on the facet joints. This includes lifting heavy items, excessive twisting or rotating, and leaning backwards or back extension. Combined movements, like holding a heavy object and twisting or rotating while bending can, in particular, increase strain on the facet joints and cause pain.

Can facet arthropathy lead to other conditions?

Yes. Facet arthropathy often occurs along with other conditions related to degenerative changes. It also can contribute to other problems within the spine. As the facet joints enlarge, they might compress nerves, leading to radiculopathy or stenosis. Facet arthropathy can also lead to instability and allow the bones of the spine to move out of alignment, which is called spondylolisthesis.

Can facet arthropathy cause sciatica?

Yes. Sciatica refers to pain symptoms that radiate from the lower back down to the leg, which is caused by compression of spinal nerves.  The facet joints are directly next to the spinal nerves and, as the facet joints grow in size from facet arthropathy, the facet joints can compress the spinal nerves. If a facet joint develops a cyst, this cyst can also compress a spinal nerve to cause pain.

What are the treatment options for facet arthropathy?

Facet arthropathy can be treated with physical therapy, medications, and interventional treatments. The goal of physical therapy is to build the muscles that surround and support the facet joints for long term relief. Anti-inflammatory medications can give temporary relief during pain flares. Interventional treatments can give long lasting relief and include both injections and ablations.

The facet joint can be injected to deliver anti-inflammatory medication such as a corticosteroid directly into the joint. However, it is more common for doctors to target the nerves that feel the facet joints.

First, the nerves (medial branch nerves) are numbed as a diagnostic injection (medial branch block) to see how much pain goes away. If numbing the nerves gives excellent pain relief, this confirms that these are the nerves transmitting the pain signal, and the nerves can then be deliberately damaged to reduce their ability to send pain signals in a procedure called an ablation. This can provide pain relief lasting 6 to 12 months. This medial branch ablation procedure is minimally invasive and can give excellent pain relief without needing surgery. This procedure is performed under fluoroscopic (X-ray) guidance to ensure correct needle placement on top of the nerves. 

Does facet arthropathy require surgery?

Generally, no, it does not. Physical therapy, medications, and interventions are successful in the large majority of cases. For people whose facet joint pain does not improve with those conservative treatments, surgical evaluation might be recommended.

What facet joint surgery options are there?

Surgery is usually reserved for instances in which the facet joint degeneration is contributing to associated with other spinal conditions, such as degenerative spondylolisthesis or stenosis. Depending on how exactly nerves in the spine are being compressed, appropriate surgical treatment may be either a form of spinal decompression surgery and/or spinal fusion.

What type of doctor treats facet arthropathy?

Facet arthropathy is most commonly treated by interventional pain physicians, physiatrists, and interventional radiologists. If surgery is considered, patients would need an evaluation by a spine surgeon.

Why should I come to HSS for treatment of facet arthropathy?

Our multidisciplinary spine team offers a collaborative environment to approach your neck or back condition with personalized recommendations and treatment options. Our clinicians include interventional pain management physicians, physiatrists, spine surgeons, neurologists, rheumatologists and physical therapists. HSS is committed to avoiding unnecessary surgeries by emphasizing physical therapy and/or interventional pain management procedures.

Key takeaways

• Facet joints are small spinal joints that enable bending and twisting. As with any other joints in the body, they can degenerate over time and become arthritic.
• Facet arthropathy often causes aching, throbbing back or neck pain, which is typically worsened by leaning backward or twisting.
• A diagnosis is based on symptoms, imaging, and sometimes diagnostic injections such as medial branch blocks.
• Conservative treatment such as physical therapy and anti-inflammatory medications is often effective. Some people may benefit from interventional pain management options such as injections or radiofrequency ablation.
• Surgery is rarely needed and generally reserved for cases with related complications, such as spinal stenosis or spondylolisthesis.