Spine Facet Joint Osteoarthritis

What Are Facet Joints

Facet joints are small synovial joints located at the posterior aspect of each spinal level. Each vertebra forms two facet joints with the level above and two with the level below.

They guide movement such as extension, rotation and side bending, while preventing excessive translation between vertebrae. The lumbar spine facets are oriented differently from the cervical spine, which explains why symptoms can vary between lower back and neck presentations.

Over time, cartilage surfaces may thin, joint capsules may thicken and osteophytes can develop. These changes represent structural adaptation, not necessarily dysfunction.

How Facet Joint Osteoarthritis Commonly Presents

Lumbar facet osteoarthritis typically causes localised lower back pain, often described as an ache or stiffness across one or both sides of the spine. Pain may increase with prolonged standing, arching backward or transitioning from sitting to standing.

Cervical facet osteoarthritis may cause neck stiffness, discomfort with rotation and localised pain that can refer into the shoulder blade region but rarely below the elbow.

Morning stiffness is common but usually settles within a short period of movement. Extended static postures, such as long car journeys or desk work, may aggravate symptoms.

Importantly, true nerve compression symptoms such as persistent leg numbness or weakness are not typical of isolated facet joint osteoarthritis and warrant further assessment.

Movement and Muscle Support

Facet joints are load-sharing structures. When spinal stabilising muscles are deconditioned or movement patterns become inefficient, compressive forces through the posterior spine may increase.

Rehabilitation therefore centres on restoring dynamic muscular support, improving movement coordination and increasing tolerance to extension and rotation where appropriate.

Avoidance of spinal movement due to fear often leads to further stiffness and reduced resilience. Controlled, graded exposure to movement improves confidence and mechanical efficiency.

The goal is not to eliminate all sensation, but to maintain function and reduce flare frequency.

Imaging Facet Joint Osteoarthritis: When Is It Helpful?

Facet joint osteoarthritis is commonly visible on MRI or CT imaging, particularly in individuals over forty. However, radiographic change is extremely common in asymptomatic populations.

X-ray may show joint space narrowing or osteophyte formation, but facet joints are more clearly visualised on MRI or CT scans.

The presence of facet degeneration on imaging does not automatically confirm it as the source of pain. Many individuals demonstrate facet changes without symptoms.

Imaging is most useful when symptoms are atypical, when neurological involvement is suspected, or when interventional procedures such as diagnostic medial branch blocks are being considered.

Treatment decisions should be guided primarily by clinical presentation and functional limitation rather than imaging findings alone.

Managing Facet Joint Osteoarthritis Flare-Ups

Spinal facet osteoarthritis often fluctuates.

Flares typically present as increased localised stiffness and pain with movement. They may follow prolonged standing, repetitive bending, heavy lifting, increased activity or extended static postures.

A flare represents heightened joint sensitivity rather than sudden structural deterioration. The facet joint capsule can become temporarily irritated, leading to protective muscle guarding and reduced movement confidence.

Management during a flare focuses on maintaining gentle mobility, avoiding prolonged static positions and gradually restoring normal movement patterns. Complete bed rest is rarely appropriate and often prolongs stiffness.

Calm, consistent movement within tolerance usually shortens recovery time.

Injection and Interventional Options

For persistent, well-localised facet-mediated pain that has not responded to structured rehabilitation, interventional options may be considered.

These may include medial branch blocks or radiofrequency ablation in selected cases. Corticosteroid injection directly into the facet joint is less common but may be used in certain scenarios.

Such interventions aim to reduce pain sufficiently to allow restoration of movement and strengthening. They do not reverse structural change.

Interventional decisions require careful clinical correlation and are typically considered only after comprehensive conservative care.

When Is Surgery Appropriate for Facet Joint Osteoarthritis?

Surgery is rarely indicated for isolated facet joint osteoarthritis.

Spinal surgery is usually considered only when there is significant neurological compromise, instability or structural pathology beyond simple facet degeneration.

Most individuals with facet-related pain manage successfully with structured physiotherapy, load management and movement optimisation.

Shared decision-making remains central, but in contrast to hip or knee osteoarthritis, surgical replacement of facet joints is not a routine treatment pathway.

Our Specialist Approach to Facet joint Osteoarthritis

Assessment focuses on movement behaviour, pain pattern, load tolerance and muscular support rather than scan findings alone.

Management emphasises progressive spinal conditioning, improving extension tolerance where appropriate, restoring rotational control and guiding flare management.

Education is a core component. Understanding that facet degeneration is common and not inherently dangerous reduces fear and improves outcomes.

Understanding Osteoarthritis

Facet joint osteoarthritis forms part of our wider specialist osteoarthritis service. For a broader understanding of how osteoarthritis behaves across different joints and how structured rehabilitation supports long-term joint health, you can explore our main osteoarthritis overview page.