What is Facet Joint Disease?

Facet joint disease, also called facet arthropathy, facet syndrome, facet arthritis, or zygapophyseal joint pain, occurs when the small joints in the back of the spine become irritated, inflamed, arthritic, or painful. Facet joints help guide spinal movement and provide stability between the vertebrae.

Facet joint disease can occur in the cervical spine in the neck, thoracic spine in the mid back, or lumbar spine in the lower back. Pain from a facet joint may stay near the spine or refer to nearby areas, such as the back of the head, shoulder, upper back, buttock, hip, or thigh.

De Novo Brain & Spine evaluates adult patients with suspected facet joint disease when symptoms suggest spine-related pain, degenerative disc disease, spinal stenosis, spondylosis, instability, radiculopathy, or another structural spine condition that may require further evaluation.

Common Signs and Symptoms

Facet joint disease symptoms depend on the affected spinal region, degree of joint irritation, posture, movement pattern, and whether other spine conditions are also present.

Common signs and symptoms may include:

• Neck pain, mid back pain, or low back pain
• Pain that is worse with extension, arching, twisting, or rotating the spine
• Stiffness after rest, sleep, or prolonged sitting
• Pain that improves temporarily with movement or position change in some patients
• Local tenderness near the affected spinal joints
• Muscle tightness or spasms near the spine
• Pain that refers to the back of the head, shoulder, or upper back when cervical facet joints are involved
• Pain that refers to the buttock, hip, or thigh when lumbar facet joints are involved
• Reduced range of motion
• Pain that worsens with standing or walking in some patients
• Pain that overlaps with degenerative disc disease, spinal stenosis, or spondylosis symptoms

Seek urgent medical evaluation for pain with progressive weakness, numbness, trouble walking, loss of coordination, bowel or bladder changes, fever, unexplained weight loss, history of cancer, severe pain after trauma, or rapidly worsening neurological symptoms. Seek emergency medical care or call 911 for sudden weakness, sudden speech difficulty, loss of consciousness, chest pain, or other emergency symptoms.

What Causes This Condition?

Facet joint disease occurs when the facet joints become irritated, inflamed, arthritic, overloaded, or structurally changed. It often develops along with other age-related or degenerative spine changes.

Possible causes and related factors may include:

• Osteoarthritis of the facet joints
• Spondylosis, meaning degenerative arthritis of the spine
• Degenerative disc disease and loss of disc height, which can increase stress on facet joints
• Repetitive extension, rotation, lifting, or twisting
• Prior spine injury or trauma
• Whiplash or cervical spine injury in selected cases
• Spondylolisthesis or abnormal spinal motion
• Spinal instability in selected cases
• Scoliosis, kyphosis, or other alignment changes that alter joint loading
• Obesity or increased mechanical stress on the spine
• Inflammatory arthritis in selected patients
• Prior spine surgery or adjacent segment stress in selected cases

These causes and risk factors do not mean every patient with facet arthritis has pain. Facet joint changes can appear on imaging in people without symptoms, so treatment planning depends on the patient’s pain pattern, examination, imaging, diagnostic testing, and overall condition.

How It Is Diagnosed?

Facet joint disease is diagnosed by combining medical history, physical examination, neurological examination, imaging, and sometimes diagnostic injections. Imaging may show arthritis or joint changes, but imaging alone does not always prove that the facet joint is the pain source.

Common diagnostic steps may include:

• Medical history and symptom review to understand pain location, stiffness, movement triggers, injury history, referred pain, prior treatment, and red-flag symptoms
• Physical examination to evaluate posture, range of motion, tenderness, muscle spasm, painful extension, rotation, and movement patterns
• Neurological examination to assess strength, sensation, reflexes, coordination, gait, balance, and signs of nerve root or spinal cord involvement
• X-rays of the spine to evaluate alignment, arthritis, disc space narrowing, spondylosis, spondylolisthesis, instability, fracture, or degenerative change
• Flexion-extension X-rays in selected cases when abnormal motion or spinal instability is suspected
• MRI of the cervical, thoracic, or lumbar spine to evaluate facet arthropathy, degenerative disc disease, spinal stenosis, nerve compression, spinal cord compression, tumor, infection, or other soft-tissue findings
• CT scan when bone detail, facet joint arthritis, fracture, or surgical planning requires further evaluation
• CT myelogram in selected cases when MRI is not possible or when additional detail around the spinal canal and nerve roots is needed
• Diagnostic medial branch blocks to help determine whether pain is coming from the small nerves that supply the facet joints
• Facet joint injections in selected cases when the joint itself is being evaluated or treated
• Electromyography and nerve conduction studies, also called EMG/NCS, when symptoms may overlap with radiculopathy, peripheral neuropathy, or another nerve disorder

The goal of diagnosis is to determine whether the facet joints are likely contributing to pain, identify any associated nerve compression or instability, and decide whether conservative care, injections, radiofrequency ablation, or surgical evaluation may be appropriate.

Treatment Options

Facet joint disease treatment depends on the affected spinal level, pain severity, movement triggers, neurological examination, imaging findings, spinal stability, prior treatment, activity limitations, and overall health. Many patients begin with non-surgical care.

Treatment options may include:

• Activity modification to reduce positions, extension, twisting, lifting, or movements that worsen symptoms
• Physical therapy to improve posture, mobility, core strength, flexibility, spinal stability, and safe movement mechanics
• Home exercise and stretching when recommended by a clinician or therapist
• Heat, ice, or other comfort measures for short-term symptom relief
• Anti-inflammatory medication, acetaminophen, muscle relaxants, or nerve pain medication when medically appropriate
• Weight management and conditioning when these factors are relevant to spine stress and overall health
• Treatment of posture, ergonomic, conditioning, or activity-related contributors
• Facet joint injection in selected cases when inflammation or joint-mediated pain is suspected
• Medial branch block to help confirm whether the facet joint nerves are contributing to pain
• Radiofrequency ablation, also called RFA, in selected patients when diagnostic medial branch blocks suggest facet-mediated pain
• Treatment of overlapping spine conditions, such as degenerative disc disease, spinal stenosis, spondylolisthesis, or radiculopathy when present
• Spinal decompression in selected cases when nerve compression or spinal stenosis is a major contributor
• Spinal fusion or stabilization in selected cases involving instability, deformity, spondylolisthesis, or other structural conditions
• Rehabilitation and follow-up care to monitor pain, mobility, function, walking, and neurological status

Surgery is not a treatment for uncomplicated facet joint pain by itself. Neurosurgical treatment may be considered when facet joint disease occurs with spinal instability, significant stenosis, nerve compression, deformity, spondylolisthesis, fracture, or another structural spine condition that may benefit from surgery.