Facet joint arthritis, also called facet arthropathy or zygapophyseal joint osteoarthritis, is a degenerative condition in which the small synovial joints on the back of the spine lose their smooth cartilage, develop bone spurs, and become inflamed, leading to localized neck or back pain and stiffness. It commonly affects the cervical (neck) and lumbar (lower back) regions, accounting for 15–45% of chronic low back pain cases SpringerOpenWexner Medical Center.
Anatomy
Structure
Each facet (zygapophyseal) joint is a paired, synovial-lined articulation formed by the inferior articular process of one vertebra and the superior articular process of the next. A fibrous capsule surrounds the joint, enclosing synovial fluid that nourishes and lubricates the articular cartilage NCBIRadiopaedia.
Location
Facet joints lie on the posterolateral aspect of each vertebral level, two on each side of the spine, from C2–C3 down to L5–S1. They guide and limit spinal motions between adjacent vertebrae NCBIRadiopaedia.
Origin & Insertion
Although joints do not “originate” or “insert” like muscles, each facet joint is formed by the convergence of two bony processes: the inferior articular process (from the vertebra above) “inserts” into the superior articular process (of the vertebra below), creating a stable gliding surface NCBI.
Blood Supply
Arterial blood reaches the facet capsules via posterior spinal branches of the segmental spinal arteries. Venous blood drains into the internal and external vertebral venous plexuses through intervertebral veins Home.
Nerve Supply
Sensory innervation arises from the medial branches of the dorsal rami of spinal nerves at the same level and one level above (in the lumbar spine). In the cervical spine, each facet receives input from the medial branches of the dorsal rami of the level above and the same level Physio-pediaHome.
Functions
Stabilization: Prevents excessive translation of vertebrae during movement.
Guidance: Directs and limits flexion, extension, rotation, and lateral bending.
Load Transmission: Bears approximately 20–25% of axial load during extension.
Protection: Shields intervertebral discs from shear forces.
Proprioception: Contains mechanoreceptors that provide feedback on spinal position.
Shock Absorption: Synovial fluid disperses forces across the joint surfaces SpringerOpen.
Types of Facet Joint Arthritis
Degenerative (Osteoarthritis): Wear-and-tear breakdown of cartilage leading to bone spur formation SpringerOpen.
Rheumatoid Arthritis: Autoimmune inflammation of the synovial lining, sometimes involving cervical facets Verywell Health.
Psoriatic Arthritis: Seronegative spondyloarthropathy affecting cervical and lumbar facets.
Ankylosing Spondylitis: Chronic inflammation causing fusion (ankylosis) of facet joints, especially in the spine.
Gouty Arthritis: Uric acid crystal deposition within the facet joint capsule.
Pseudogout (CPPD): Calcium pyrophosphate crystals in the joint space.
Septic (Infectious) Arthritis: Bacterial invasion of the facet joint, a rare but serious cause of acute pain and fever PMC.
Post-Traumatic Arthritis: Following facet fractures or ligament injuries.
Congenital/Developmental: Malformed facet orientation predisposes to early wear.
Metabolic Arthropathy: Secondary to systemic conditions like hemochromatosis.
Causes of Facet Joint Arthritis
Age-Related Wear & Tear: Natural cartilage breakdown over decades SpringerOpen.
Repetitive Microtrauma: Occupational bending or twisting stresses the facets SpringerOpen.
Acute Trauma: Falls or car accidents fracture articular processes Spine & Orthopedic Doctor in Vero Beach.
Obesity: Excess weight increases axial load on facet joints NCBI.
Poor Posture: Chronic slouching alters load distribution Mayfield Brain & Spine.
Spinal Instability: Spondylolisthesis increases facet wear Spine-health.
Congenital Facet Orientation: Abnormal angles hasten degeneration.
Inflammatory Arthritides: RA or PsA can involve facets Verywell Health.
Metabolic Disorders: Gout or CPPD crystal deposition Mayo Clinic.
Degenerative Disc Disease: Disc height loss shifts load to facets Verywell Health.
Smoking: Impairs disc nutrition and joint health.
Genetic Predisposition: Family history of OA.
Diabetes Mellitus: Advanced glycation end-products harm cartilage.
Vitamin D Deficiency: Poor bone and joint remodeling.
High-Impact Sports: Gymnastics, football increase facet stresses.
Occupational Vibration: Truck drivers have higher risk.
Corticosteroid Overuse: Weakens joint capsules.
Infection: Septic arthritis from hematogenous spread PubMed.
Facet Synovial Cysts: Joint effusion and cysts erode cartilage.
Previous Spinal Surgery: Altered biomechanics accelerate wear.
Symptoms of Facet Joint Arthritis
Localized Back Pain: Aching pain centered over the affected facet SpringerOpen.
Neck Pain: Stiffness and discomfort in cervical facets Wexner Medical Center.
Morning Stiffness: Lasting <30 minutes, improves with movement Verywell Health.
Pain on Extension: Symptoms worsen when leaning backward.
Pain on Rotation: Discomfort turning head or trunk.
Referred Buttock Pain: Lumbar facet pain radiates to buttocks.
Referred Shoulder Pain: Cervical facet pain mimics shoulder strain.
Tenderness to Palpation: Point tenderness adjacent to spinous processes.
Reduced Range of Motion: Difficulty bending or twisting.
Muscle Spasm: Paraspinal muscle guarding.
Crepitus: Grinding sensation on movement.
Intermittent Sharp Flare-Ups: Sudden exacerbations.
Headaches: Occipital headaches from upper cervical facets.
Leg or Arm Pain: Referred radicular-like pain without nerve compression.
Joint Swelling: Rare, seen in acute inflammatory or infectious cases PMC.
Night Pain: Interrupts sleep in advanced cases.
Neurological Symptoms: Numbness or tingling if severe osteophytes compress nerves.
Fatigue: Chronic pain leads to tiredness.
Loss of Balance: Cervical involvement can affect proprioception.
Systemic Signs: Fever/chills in septic facet arthritis Journal of Clinical Imaging Science.
Diagnostic Tests for Facet Joint Arthritis
X-Ray: Shows joint space narrowing and osteophytes Radiopaedia.
Computed Tomography (CT): Detailed bony anatomy, osteophyte visualization Radiopaedia.
Magnetic Resonance Imaging (MRI): Assesses cartilage, synovitis, nerve impingement SpringerOpen.
Bone Scan: Highlights increased uptake in active arthritic joints.
Ultrasound: Detects synovial inflammation and guides injections.
Diagnostic Facet Block: Local anesthetic injection; >50% pain relief confirms source Verywell Health.
Medial Branch Block: Anesthetic to medial branches isolates facet pain Spine-health.
Electrodiagnostic Studies: Rule out radiculopathy.
Laboratory Tests: ESR, CRP to exclude inflammatory or septic arthritis Mayo Clinic.
Joint Aspiration: Rare but diagnostic in suspected septic cases Mayo Clinic.
Flexion-Extension X-Rays: Evaluate instability.
Provocative Maneuvers: Kemp’s and Jackson’s tests in physical exam.
Facet Joint Arthroscopy: Direct visualization in specialized centers.
Single-Photon Emission CT (SPECT): Combines CT and bone scan.
Dual-Energy CT: Identifies crystal arthropathies (gout, CPPD).
Facet Cyst Detection: MRI or CT shows synovial cysts.
Vertebral Motion Analysis: Quantifies segmental movement.
DIScography: Differentiates discogenic vs. facet pain.
CT-Guided Biopsy: In suspected infection or tumor.
PET-CT: Rare, for neoplastic causes.
Non-Pharmacological Treatments
Physical Therapy: Tailored exercises improve strength and flexibility Spine-health.
Core-Stabilization Exercises: Support spinal segments.
Manual Therapy: Joint mobilization and manipulation Physio-pedia.
Yoga: Enhances flexibility and posture.
Pilates: Focuses on controlled spinal movements.
Tai Chi: Improves balance and joint health.
Aquatic Therapy: Water buoyancy reduces load on joints.
Heat Therapy: Eases muscle tension and stiffness Carle Health | Your care starts here..
Cold Therapy: Decreases inflammation post-exercise.
Transcutaneous Electrical Nerve Stimulation (TENS): Modulates pain signals.
Ultrasound Therapy: Deep tissue heating.
Laser Therapy: Promotes tissue repair.
Acupuncture: Stimulates endogenous pain relief pathways.
Chiropractic Care: Adjustments to improve joint mechanics.
Ergonomic Modifications: Workplace adjustments reduce stress.
Weight Loss: Lowers axial compressive forces NCBI.
Posture Training: Prevents abnormal load distribution.
Lifestyle Counseling: Reduces risk factors (smoking, poor diet).
Cognitive Behavioral Therapy: Addresses pain-related coping.
Biofeedback: Improves muscle control.
Brace or Orthosis: Limits painful movements.
Spinal Traction: Temporarily relieves compression.
Night Splints: Maintains neutral posture during sleep.
Massage Therapy: Relieves muscle spasm.
Ergonomic Sleep Setup: Proper mattress and pillow support.
Activity Modification: Avoidance of provocative activities.
Hydrotherapy: Contrast baths to manage inflammation.
Mind-Body Practices: Meditation to lower pain perception.
Nutritional Counseling: Anti-inflammatory diet advisory.
Patient Education: Self-management strategies Spine-health.
Drugs (Pharmacological Treatments)
Ibuprofen (NSAID): Inhibits COX enzymes to reduce pain and inflammation; dosed 400–800 mg every 6–8 h Medscape.
Naproxen (NSAID): Long-acting COX inhibitor; 250–500 mg twice daily Spine Connection.
Celecoxib (COX-2 Inhibitor): Lowers GI side effects; 100–200 mg daily Spine Connection.
Diclofenac Gel (Topical NSAID): Direct application to painful areas; up to 4 g per joint area 4 times/day Verywell Health.
Meloxicam (NSAID): Preferential COX-2 inhibition; 7.5–15 mg daily.
Indomethacin (NSAID): Potent anti-inflammatory; 25–50 mg two to three times daily.
Piroxicam (NSAID): Long half-life; 20 mg once daily.
Ketorolac (NSAID): Short-term use only; 10 mg every 4–6 h for ≤5 days.
Acetaminophen: Analgesic; up to 3 g daily for mild pain Carle Health | Your care starts here..
Tramadol: Weak opioid reuptake inhibitor; 50–100 mg every 4–6 h Minnesota Spine Institute.
Codeine: Mild opioid; 15–60 mg every 4–6 h as needed.
Morphine: Strong opioid for severe cases; individualized dosing.
Gabapentin: Gabapentinoid for neuropathic pain; 300–1200 mg nightly Verywell Health.
Pregabalin: Similar to gabapentin; 75–150 mg twice daily Verywell Health.
Cyclobenzaprine: Muscle relaxant; 5–10 mg at bedtime.
Baclofen: GABA-B agonist for spasm; 5–20 mg 3 times daily.
Duloxetine (SNRI): Modulates descending pain pathways; 30–60 mg daily.
Amitriptyline (TCA): Neuromodulator; 10–25 mg at bedtime.
Prednisone (Oral Corticosteroid): Short-course 5–10 mg tapered over days.
Triamcinolone Acetonide (Injection): Corticosteroid injected into facet joint for sustained relief InsideRadiology.
Surgeries
Radiofrequency Ablation (Facet Rhizotomy): Thermally lesions medial branch nerves to block pain transmission SpringerOpen.
Cryoablation: Freezes medial branch nerves for similar effect; alternative to RF ablation SpringerOpen.
Facet Joint Denervation: Surgical interruption of nerve supply under direct vision.
Lumbar/Lumbar Fusion: Arthrodesis of painful segments to stabilize joints Spine & Orthopedic Doctor in Vero Beach.
Cervical Fusion: Fuses unstable or arthritic cervical segments.
Laminectomy: Removal of lamina and part of facet to decompress neural elements Spine-health.
Lumbar Facetectomy: Excision of hypertrophic facet for decompression Medscape.
Foraminotomy: Widening neural foramen by trimming facet bone Mayfield Brain & Spine.
Laminotomy: Partial lamina removal to relieve pressure while preserving stability Mayfield Brain & Spine.
Spinal Decompression: Combined laminectomy, facetectomy, and foraminotomy for multilevel disease Mayfield Brain & Spine.
Preventive Measures
Maintain a Healthy Weight: Reduces axial load on facet joints NCBI.
Regular Low-Impact Exercise: Swimming or walking strengthen support muscles Patient Care at NYU Langone Health.
Core Strengthening: Improves spinal stability Spine-health.
Good Posture: Prevents uneven joint stress Mayfield Brain & Spine.
Ergonomic Workstation: Proper desk/chair alignment reduces strain.
Avoid Prolonged Sitting: Take breaks and stretch every 30 minutes.
Warm-Up Before Activity: Prepares joints and muscles Carle Health | Your care starts here..
Balanced Diet: Anti-inflammatory foods support joint health.
Adequate Hydration & Nutrition: Keeps discs and joints nourished.
Avoid Smoking: Promotes better cartilage and bone health.
When to See a Doctor
Seek medical evaluation if back or neck pain persists beyond two weeks despite home care; if you experience neurological signs (numbness, weakness, bowel/bladder changes); or if pain is severe, constant, or accompanied by fever, weight loss, or unrelenting night pain Verywell Health.
Frequently Asked Questions
What exactly causes facet joint arthritis?
Age-related cartilage wear, repetitive stress, trauma, and inflammatory conditions all contribute to facet joint degeneration SpringerOpen.How is facet arthritis different from a slipped disc?
Facet arthritis is a joint problem; a slipped disc (herniation) involves intervertebral disc material pressing on nerves. Their pain patterns and treatments differ SpringerOpen.Can facet joint arthritis be cured?
There is no cure; treatments focus on pain relief, improving function, and slowing degeneration with conservative care or interventions NCBI.Are injections safe?
Facet joint injections under image guidance are generally safe but carry small risks of bleeding, infection, or nerve injury InsideRadiology.How long do RF ablation results last?
Radiofrequency ablation can relieve pain for 6–12 months; repeat procedures may be performed as needed SpringerOpen.Will weight loss help my back pain?
Yes—losing excess weight reduces stress on spinal joints and improves symptoms NCBI.What exercises are best?
Core stabilization, gentle stretching, and low-impact aerobic activities under therapist guidance are ideal Spine-health.Is surgery my only option?
Surgery is reserved for refractory cases with neurological compromise or severe structural instability; most patients improve with non-surgical care Spine-health.How often can I get facet injections?
Typically no more than two therapeutic injections in a six-week period; diagnostic blocks can be closer if needed Hospital for Special Surgery.Can smoking worsen arthritis?
Yes—smoking impairs tissue healing and accelerates joint degeneration NCBI.Are there natural remedies?
Some find relief with acupuncture, anti-inflammatory diets, or supplements (e.g., omega-3s), but evidence varies Health.What’s the difference between a facet block and an injection?
They’re the same procedure; “block” often emphasizes diagnostic use, while “injection” may include steroids for therapy Hospital for Special Surgery.Can facet arthritis cause sciatica?
Yes—lumbar facet osteophytes can irritate nearby nerve roots, mimicking sciatica SpringerOpen.How fast does facet arthritis progress?
Progression varies—some remain stable for years, others worsen over months. Early care can slow changes SpringerOpen.Is facet arthritis hereditary?
Genetic factors influence cartilage resilience and joint shape, so family history can increase risk SpringerOpen.
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Last Updated: May 04, 2025.
