FAQs on Facet Joint Syndrome (Spinal Arthritis)

The facet joints are structures that connect the spinal vertebrae to one another. Like other joints of the body, they have cartilage that line the joint, which allows the bone to glide smoothly against another bone. The facet joint functions to provide stability, support, and mobility to the vertebrae and spine.

Facet joint syndrome, also called spinal arthritis, occurs when these joints degenerate from wear-and-tear. Facet joint pain is present in 40% of the elderly population and up to 15% of younger adults who have sustained an injury. Approximately 10% of patients with low back pain have lumbar facet joint disease.

What causes facet joint syndrome?

Facet joint syndrome is caused by erosion of cartilage in the facet joints. Injury to the spine can contribute to the condition, as can over-use, excessive strain, and injury. Spondylolithesis occurs when one vertebra slips forward, and this can contribute to spinal arthritis.

What are the risk factors for facet joint syndrome?

The primary risk factor for any type of arthritis is aging or growing old. Other risk factors include trauma, physical injury, temporary or permanent loss of blood supply to the vertebral bones (osteonecrosis), abnormal development of spinal structures (dysplasias), and inflammatory arthritis.

What are the symptoms of facet joint syndrome?

The symptoms of facet joint syndrome are usually localized to the particular joint that is affected. The arthritis can occur in the neck (cervical spine), middle back (thoracic spine), and/or lower back (lumbar spine).

A person can experience low back pain when the syndrome affects the lower back, and the pain can radiate to the buttocks and/or thighs. If the syndrome affects the neck region, the pain can occur in the neck and radiate to the shoulders or upper arms.

How is facet joint syndrome diagnosed?

If the doctor suspects that you have facet joint syndrome, he/she will order diagnostic imaging tests, such as a CT scan or an MRI. A bone scan is done to assess for active inflammation of the spine.

To determine which facet joints are involved, the doctor may perform a facet joint injection. In this procedure, he/she injects the facet joint with a mixture of corticosteroid medication and an anesthetic agent. Improvement of pain is immediate if facet joint syndrome is present.

What are the treatment options for patients with spinal arthritis?

  • Medications – The pain specialist can prescribe a number of medications to treat back pain associated with facet joint syndrome, as well as the associated symptoms. Nonsteroidal anti-inflammatory agents and muscle relaxants are often beneficial.
  • Laser or radiofrequency facet thermal ablation – If the FJI relieves pain, the doctor can perform a facet thermal ablation. A small tube is inserted into the joint, and a laser or heated device is used to debride (clean) the joint and deaden the nearby nerve. In a large review of randomized controlled trials, numerous studies reported moderate evidence that these procedures are effective for chronic low back pain.
  • Epidural steroid injection (ESI) – With the ESI, the doctor uses x-ray guidance (fluoroscopy) to inject a steroid medication into the epidural space, which lies between the epidural layer and the spinal cord. The corticosteroid provides long-lasting pain relief by decreasing inflammation. More than half of recent controlled research studies show positive findings for ESI when used for pain related to spinal disease.
  • Medial branch block – This involves the injection of a local anesthetic near the two small nerves that go into the facet joint. Several joints are often treated at once. In a 2007 clinical study, almost 70% of study participants reported pain relief after this block.