Facet joint osteoarthritis (FJOA) is a common degenerative condition of the spine’s zygapophysial joints that can cause chronic back or neck pain.
Facet joint osteoarthritis is a wear-and-tear disease affecting the small synovial joints (facet or zygapophysial joints) that connect adjacent vertebrae in the spine. Over time, the cartilage within these joints breaks down, leading to joint space narrowing, bone spur formation, and inflammation. This process can irritate nearby nerves, causing pain, stiffness, and reduced motion in the back or neck RadiopaediaHome.
Anatomy of the Facet Joints
Structure and Location
Facet joints are paired, flat (plane) synovial joints formed by the superior articular process of one vertebra and the inferior articular process of the vertebra above it. They run in oblique planes along the back (posterior) part of the spine at every level from the cervical (neck) to the lumbar (lower back) region WikipediaRadiopaedia.
Origin and Insertion
Unlike muscles, joints do not “originate” or “insert,” but the bony surfaces they connect can be described similarly. The “origin” surface is the inferior articular process of the upper vertebra, and the “insertion” surface is the superior articular process of the lower vertebra. Together, these surfaces bear loads and guide spinal movement Wikipedia.
Blood Supply
Small arteries branch from the segmental spinal arteries (posterior branches of vertebral, intercostal, or lumbar arteries) to supply the facet joint capsule and subchondral bone. These vessels travel through the intervertebral foramina alongside nerves Home.
Nerve Supply
Each facet joint is “dually innervated” by medial branch nerves of the dorsal (posterior) rami from the same spinal level and the level above (except at C2–C3 and C7–T1, which have slightly different patterns). These nerves carry pain signals when the joint is irritated WikipediaWheeless’ Textbook of Orthopaedics.
Functions
Guide Flexion and Extension
Facet joints allow forward bending (flexion) and backward bending (extension) while preventing excessive motion Wikipedia.Limit Rotation
They restrict excessive twisting of the spine to protect the spinal cord and nerves Wikipedia.Control Lateral Bending
Facets help guide side-to-side motions of the spine Wikipedia.Bear Axial Loads
Especially in the lumbar region, they share weight-bearing duties with intervertebral discs Wikipedia.Maintain Spinal Alignment
Their joint surfaces keep vertebrae aligned and prevent slippage (spondylolisthesis) Wikipedia.Protect Against Shear Forces
They safeguard the spine from forward or backward shear stresses during movement Wikipedia.
Types of Facet Joint Osteoarthritis
Primary (Degenerative) FJOA
Age-related wear-and-tear without an obvious cause.Secondary (Post-traumatic) FJOA
Develops after injury, surgery, or spinal deformity.Inflammatory FJOA
Accompanied by synovitis and often linked to autoimmune conditions.Metabolic FJOA
Associated with crystal deposition diseases like gout or CPPD (pseudogout).Cervical FJOA
Affects facet joints in the neck (C1–C7).Thoracic FJOA
Occurs in the mid-back (T1–T12).Lumbar FJOA
Involves lower back joints (L1–L5), most common due to high load.Atlantoaxial (C1–C2) OA
Special joint at the top of the spine, can lead to neck pain.Facet Hypertrophic OA
Marked by large bone spurs narrowing the joint space.Adjacent-Segment FJOA
Develops above or below a spinal fusion surgery Home.
Causes
Aging
Cartilage naturally wears out over time Mayo Clinic.Genetics
Some families inherit weaker cartilage or abnormal joint shapes Mayo Clinic.Obesity
Extra weight increases stress on the joints Mayo Clinic.Repetitive Stress
Overuse from sports or work can accelerate wear Mayo Clinic.Joint Injuries
Fractures or sprains damage cartilage Mayo Clinic.Degenerative Disc Disease
Thinning discs transfer more load to facets Mayo Clinic.Poor Posture
Slouched positions add uneven stress Rheumatology Advisor.Occupational Hazards
Heavy lifting or vibration (e.g., drivers) increases risk Mayo Clinic Health System.Smoking
Impairs blood flow to joint tissues Cleveland Clinic.Metabolic Disorders
Gout or CPPD crystals can invade the joint Rheumatology Advisor.Inflammatory Diseases
Rheumatoid arthritis or ankylosing spondylitis Rheumatology Advisor.Spinal Deformities
Scoliosis or spondylolisthesis alters joint mechanics.Past Spine Surgery
Fusion may increase strain on adjacent facets.Hormonal Changes
Post-menopausal women have higher OA rates.Diabetes
May affect cartilage health.Vitamin D Deficiency
Weakens bone and cartilage.High-Impact Sports
Football, gymnastics, and weightlifting.Sedentary Lifestyle
Weak muscles offer less joint support.Poor Core Strength
Leads to unbalanced spinal loading.Trauma
Car accidents or falls Rheumatology Advisor.
Symptoms
Localized Back/Neck Pain
Dull ache near the affected joint Wikipedia.Stiffness
Especially after rest Wikipedia.Reduced Range of Motion
Difficulty bending or turning Wikipedia.Referred Pain
Pain felt in buttocks, shoulders, or legs Wikipedia.Muscle Spasm
Protective contraction of nearby muscles Wikipedia.Tenderness
Pain when pressure is applied to the joint.Crepitus
Grinding or popping sounds during movement Wikipedia.Pain on Extension
Worsened when arching the back.Pain on Rotation
Increased discomfort when twisting.Leg Pain
When lumbar facets press on nerve roots Wikipedia.Headaches
From upper cervical joints.Numbness or Tingling
If nerve roots are affected.Weakness
In arms or legs in severe cases.Feeling of Instability
Spine feels “unstable” or wobbly.Morning Pain
Stiffness and discomfort upon waking.Pain After Activity
Worse after prolonged standing or walking.Pain Relief with Flexion
Bending forward often eases lumbar pain.Night Pain
Sometimes wakes patients at night.Fatigue
Chronic pain can cause tiredness.Locking
Occasional “catching” sensation in the spine.
Diagnostic Tests
Clinical History and Exam
Assessment of pain patterns and physical tests Wikipedia.Kemp’s Test
Extension–rotation to reproduce pain Wikipedia.Extension–Rotation Test
Similar to Kemp’s, for facet loading.Plain X-Rays
Show joint space narrowing and bone spurs.Computed Tomography (CT)
Detailed bone view of facets.Magnetic Resonance Imaging (MRI)
Shows cartilage, bone marrow edema, and nerve impingement.Bone Scan
Detects active bone remodeling.SPECT (Single-Photon Emission CT)
Localizes active facet inflammation.Ultrasound
Limited but can guide injections.Diagnostic Facet Joint Injection
Relief after joint injection confirms source Spine-health.Medial Branch Block
Numbing the nerve supply tests pain origin Spine-health.Fluoroscopy-Guided Injection
Ensures accurate needle placement.Provocative Discography
Rules out discogenic pain.Electromyography (EMG)
Assesses nerve function if radiculopathy suspected.Nerve Conduction Studies
Measures nerve impulse speed.Laboratory Tests
ESR and CRP to exclude inflammatory arthritis Pain Physician Journal.Facet Joint Effusion Sign
Fluid seen on MRI suggests instability PMC.Dynamic X-Rays
Flexion–extension films to detect instability.Disc Height Measurement
Correlates with facet loading.Spinal Alignment Evaluation
Sagittal balance on standing films SpringerOpen.
Non-Pharmacological Treatments
Physical Therapy
Guided exercises for strength and flexibility Mayo Clinic Proceedings.Core Strengthening
Improves spinal support.Aerobic Exercise
Low-impact activities like walking or swimming Physio-pedia.Stretching
Hamstring and spinal stretches.Yoga and Pilates
Enhance flexibility and posture.Tai Chi
Gentle movements for balance.Manual Therapy
Hands-on techniques by therapists.Chiropractic Adjustments
Spinal mobilization.Heat Therapy
Improves circulation and relaxes muscles.Cold Therapy
Reduces inflammation.Transcutaneous Electrical Nerve Stimulation (TENS)
Stimulates endorphin release.Massage Therapy
Relieves muscle tension.Acupuncture
May modulate pain pathways.Posture Training
Ergonomic corrections at work Mayo Clinic Proceedings.Bracing
Lumbar supports for acute flare-ups.Traction Therapy
Decompresses spinal segments.Hydrotherapy
Pool-based exercise reduces joint load.Back School Education
Teaches spine-safe lifting and movement.Mindfulness and CBT
Addresses pain perception.Weight Management
Reduces joint stress Mayo Clinic Health System.Ergonomic Chairs
Lumbar support at workstations.Cushions and Rolls
Maintains spinal curves in sitting.Kinesiology Taping
Provides proprioceptive feedback.Ultrasound Therapy
Deep heat to joint tissues.Shockwave Therapy
May aid tissue repair.Dry Needling
Targets myofascial trigger points.Prolotherapy
Injections to promote ligament healing.Neurostimulation
Implanted devices in refractory cases.Ergonomic Footwear
Shock-absorbing shoes.Home Exercise Programs
Daily self-management routines.
Pharmacological Treatments
Acetaminophen
First-line for mild pain; no anti-inflammatory effect MedscapeWikipedia.Ibuprofen
OTC NSAID for pain and inflammation Medscape.Naproxen
Longer-acting NSAID.Diclofenac
Available oral or topical.Celecoxib
COX-2-selective NSAID.Meloxicam
Once-daily NSAID.Indomethacin
For more severe inflammation.Piroxicam
Long-half-life NSAID.Ketorolac
Short-term, potent NSAID.Topical Diclofenac Gel
Local pain relief with fewer side effects.Capsaicin Cream
Depletes substance P from nerve endings.Lidocaine Patch
Numbs local nerves.Cyclobenzaprine
Muscle relaxant for spasm relief.Tizanidine
Short-acting antispasmodic.Tramadol
Weak opioid with SNRI action.Oxycodone/Acetaminophen
Combination for moderate pain.Duloxetine
SNRI for chronic musculoskeletal pain.Gabapentin/Pregabalin
For neuropathic symptoms.Corticosteroid Injection
Direct anti-inflammatory into the joint Spine-health.Hyaluronic Acid Injection
Lubricates joint space.
Surgeries and Interventions
Radiofrequency Ablation (RFA)
Destroys medial branch nerves for longer pain relief CMS.Facetectomy
Removal of part or all of the facet to decompress nerves Radiology Key.Laminectomy with Medial Facetectomy
Removes lamina and part of facets to widen spinal canal SpringerOpen.Posterior Lumbar Interbody Fusion (PLIF)
Fusion of vertebrae and facets from the back Radiopaedia.Transforaminal Lumbar Interbody Fusion (TLIF)
Fusion via a posterolateral approach.Extreme Lateral Interbody Fusion (XLIF/LLIF)
Side approach to fuse and decompress.Anterior Cervical Discectomy and Fusion (ACDF)
Fusion for cervical facet OA.Artificial Facet Replacement (FIREBIRD, TOPS, ACADIA)
Prosthetic joint to restore motion Wikipedia.Dynamic Stabilization (e.g., Dynesys)
Non-fusion systems that stabilize but allow movement.Endoscopic Facet Decompression
Minimally invasive removal of bone spurs.
Prevention Strategies
Maintain a Healthy Weight
Reduces spinal load Mayo Clinic.Stay Active
Low-impact exercise preserves joint health Physio-pedia.Strengthen Core Muscles
Improves spinal support.Practice Good Posture
Even weight distribution on facets Mayo Clinic Proceedings.Use Ergonomic Furniture
Supports natural spinal curves.Lift Safely
Bend knees, not the back.Avoid High-Impact Activities
Jumping or heavy contact sports.Quit Smoking
Enhances blood flow to joints.Balanced Diet
Provides nutrients for cartilage.Regular Stretching
Keeps spinal joints mobile.
When to See a Doctor
If you experience persistent back or neck pain lasting more than 4–6 weeks, severe pain that limits daily activities, neurological symptoms (numbness, tingling, weakness), loss of bladder or bowel control, unexplained weight loss, or fever, seek medical evaluation promptly Home.
Frequently Asked Questions
1. What exactly is facet joint osteoarthritis?
Facet joint osteoarthritis is the degeneration of the spinal facet joints, leading to cartilage loss, bone spur growth, and inflammation that causes pain and stiffness.
2. How is it different from other back problems?
Unlike disc degeneration, FJOA primarily affects the small posterior joints and often presents with pain on backward bending rather than forward flexion.
3. Who is at risk for developing FJOA?
Risk factors include aging, obesity, repetitive stress, prior spinal injury or surgery, and certain inflammatory or metabolic conditions.
4. What are the main symptoms?
Typical signs are localized back or neck pain, stiffness, reduced motion, crepitus, muscle spasms, and sometimes pain radiating to the limbs.
5. How is FJOA diagnosed?
Diagnosis involves clinical history, physical tests (e.g., Kemp’s test), imaging (X-ray, CT, MRI), and diagnostic injections to confirm the facet joint as the pain source.
6. Are there exercises I can do at home?
Yes. Gentle core strengthening, stretching hamstrings and paraspinal muscles, and low-impact aerobics like walking or swimming help maintain joint health.
7. Can weight loss really make a difference?
Losing excess weight lowers stress on the facet joints, often reducing pain and slowing progression.
8. When are injections recommended?
If conservative measures fail after 6–12 weeks, corticosteroid or hyaluronic acid injections can provide diagnostic and therapeutic relief.
9. What is radiofrequency ablation?
RFA is a minimally invasive procedure that destroys the nerves supplying the painful joint, offering relief for several months to years.
10. Is surgery always necessary?
No. Most people improve with non-surgical treatments. Surgery is reserved for severe cases with neurological compromise or instability.
11. Can facet joints regenerate?
Cartilage has limited self-repair ability. Research into regenerative treatments (e.g., stem cells) is ongoing but not yet standard.
12. Are supplements like glucosamine helpful?
Evidence is mixed. Some patients report mild benefit, but supplements should complement, not replace, proven therapies.
13. How do I prevent flare-ups?
Maintain activity, practice good posture, use ergonomics, and avoid heavy lifting to reduce joint stress.
14. What is the long-term outlook?
With proper management, many people maintain good function. Progression can be slowed with lifestyle changes and treatments.
15. Can physical therapy cure FJOA?
Therapy cannot reverse joint damage but can significantly reduce pain, improve motion, and delay or prevent surgery.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members
Last Updated: May 04, 2025.
