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Facet Arthropathy

What Is Facet Arthropathy?

Facet arthropathy, also known as facet osteoarthritis, is a type of wear-and-tear arthritis affecting the spine. It affects the bony protrusions, called facet joints, that connect the bones of the spine. Symptoms include neck and back pain which can get worse with standing, twisting, or bending.

Facet arthropathy is diagnosed using X-rays or other imaging studies. Treatment includes over-the-counter pain relievers, prescription muscle relaxers, exercise, and spinal manipulation. Severe cases may require surgery.

What Are Facet Joints?

Facet joints are found along the back of the spine. They help maintain the alignment of the spinal bones (vertebrae) and limit excessive motion. There are 24 vertebrae that form the spine, with two facet joints between each.

The facet joints, along with a cushioning pad called an intervertebral disc, form a three-joint complex between each vertebra. Synovialfluid lubricates the joints so they can move easily.

Facet Arthropathy Symptoms

By definition, arthropathy refers to any type of disease affecting a joint, including arthritis. Osteoarthritis is a specific type of arthropathy, also known as arthrosis, which is a non-inflammatory, degenerative type of arthritis

Pain is the main symptom of facet arthropathy. The pain is typically worse in the morning when awakening and later in the evening, The pain can also get worse when twisting or bending backward. Bending forward often relieves the pain.

The symptoms can vary based on the part of the spine that is affected. Low back pain is the most common complaint, a condition referred to as lumbar facet arthropathy because it affects the lumbar spine of the lower back.

Symptoms include:

Dull or aching pain on both sides of the spine

Radiating pain to the buttocks and legs

Clicking sounds or "catching" sensations when moving the spine

Pins-and-needles sensations in the hands or feet

Muscle spasms or cramps

Muscle weakness

What Causes Facet Arthropathy?

Facet arthropathy is a type of degenerative arthritis that causes progressive damage to the spine. Spinal osteoarthritis (also known as spondylosis) is the most common cause, but it can occur with a severe form of spinal arthritis known as ankylosing spondylitis .

Arthritis in the facet joints can develop due to:

Aging-related wear and tear

A previous back injury

Spinal fractures

Torn ligaments

Disc problems

The deterioration of facet joints can also cause bony overgrowths called osteophytes

(bone spurs). These can cause radiating pain and restrict the range of motion of the spine.

Pathology: The pathology of retrolisthesis involves several anatomical and physiological changes:

Vertebral Slippage: A backward displacement of one vertebra relative to the vertebra below it. The degree of slippage can be classified as mild, moderate, or severe.

Disc Degeneration: The intervertebral discs may become worn or degenerate, reducing their ability to cushion the vertebrae effectively. This degeneration can contribute to instability and slippage.

Facet Joint Dysfunction: The facet joints, which help stabilize the vertebrae, may become arthritic or misaligned, contributing to spinal instability and backward displacement.

Ligamentous Instability: The ligaments supporting the spine may become lax or weakened, contributing to the slippage and instability of the vertebrae.

Spinal Canal Narrowing: Retrolisthesis can reduce the diameter of the spinal canal, leading to spinal stenosis, which compresses the spinal cord or nerve roots and results in pain, numbness, and other neurological symptoms.

Nerve Impingement: The backward displacement can compress or pinch the nerves exiting the spinal column, causing pain, numbness, tingling, and muscle weakness in the affected areas.

Risk Factors for Developing Lumbar Facet Joint Arthropathy

The lumbar spine is designed to support much of the body weight and its health is very crucial for the proper functioning of the spinal structure. Some of the risk factors of lumbar facet arthropathy include:

Body weight: Overweight or obese individuals are more prone to lumbar facet arthropathy.

Age: Older people are more prone to lumbar facet arthropathy.

Sex: Women outnumber men in terms of developing lumbar facet arthropathy.

Heredity: Some individuals are more prone to facet arthropathy due to their family history or genetics.

Heredity

Some people may be prone to developing facet arthropathy due to their genetics or have a family history of the condition. Heredity may play a role in the breakdown or degeneration of discs in the back, which can lead to facet arthropathy.

Other forms of osteoarthritis may occur alongside facet arthropathy. These other types of osteoarthritis, which may affect the hip and knee, are linked to genetics. It is possible that facet arthropathy also carries this risk factor.

Diagnosis of Facet Arthropathy

Imaging studies are central to the diagnosis of facet arthropathy. There are several types that not only confirm the diagnosis but also characterize the nature and severity of your condition:

Bone scan: Aids in evaluating bone density and detect active areas of inflammation in the spine

X-ray: which provides a plain black-and-white image of the spinal column

Computed tomography (CT): which composites multiple X-rays to create a three-dimensional image of the spinal column

Magnetic resonance imaging (MRI): which uses powerful magnetic and radio waves to visualize soft tissues such as ligaments and cartilage

The diagnosis can be confirmed with a diagnostic block. This involves the injection of a small amount of local anesthetic into a facet joint. The placement of the needle is directed either with an ultrasound or a CT scan. Facet arthroplasty is confirmed if the injection is able to provide immediate relief.

Your healthcare provider may also want to exclude other possible causes as part of the differential diagnosis. This includes conditions that mimic facet arthropathy, such as:

Herniated disc

Psoriatic arthritis

Reactive arthritis

Spinal gout

Spinal compression fracture

Treatment of Facet Arthropathy

The treatment of facet arthropathy varies based on its location and severity. As a general rule, conservative treatments are used before more invasive procedures are considered.

Lifestyle Changes

Initially, your healthcare provider may recommend a period of rest and the avoidance of aggravating movements, including any activity that involves bending or twisting. Activities that take the weight off the facet joint, such as sitting, leaning forward, or changing positions may help ease the pain.

You may also be advised to adjust your sleep positions to take the pressure off facet joints. Options included curling up on your side or lying on your back with your knees propped up with pillows.

Medications

If a diagnostic block was used, you may not need any immediate pain medications. But as the anesthetic starts to wear off, you may be prescribed over-the-counter or prescription pain relievers based on the severity of your pain.

Options include:

Analgesics like Tylenol (acetaminophen)

Nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen)

Muscle relaxants like Lloresal (baclofen) for acute back pain

Antidepressants like Cymbalta (duloxetine) for chronic back pain

Physical Therapy and Exercise

Physical therapy is a cornerstone of the treatment of lower back pain. The treatment plan should include exercises tailored to strengthen the core muscles and avoid stress on the spine.

Examples include:

Mechanical traction to help decompress the spine

Knee-to-chest stretches, hugging your knees for 30 to 60 seconds

Aquatic therapy to alleviate pressure on the spine while exercising

Walking for 10 to 20 minutes per day

Surgery and Specialist Procedures

If conservative measures fail, your healthcare provider may recommend specialist procedures or surgeries, such as:

Lumbar intra-articular injections, which deliver an anesthetic or corticosteroid (steroid) into the spine for longer-lasting pain relief

Sinuvertebral nerve ablation, which destroys spinal nerves with a strong electrical current

Extracorporeal shockwave therapy (ESWT), which delivers low- or high-energy electrical pulses to help ease pain

Stem cell regeneration, an experimental procedure in which your own stem cells are harvested and injected into damaged joints to potentially restore function

Facet rhizotomy, a surgical procedure used to sever one of the nerves supplying the facet joint

Spinal fusion surgery, a surgery that fuses two or more vertebrae to eliminate movement and pain in the facet joints

Prevention

Although it is not always possible to prevent facet arthropathy, there are steps a person can take to reduce their risk of developing it. These include:

Maintaining a healthy body weight. Being overweight increases the risk of osteoarthritis and facet arthropathy.

Exercising regularly. Walking, swimming, and other low-impact activities are easy on the joints and can help keep them moving smoothly.

Avoiding injuries. Accidents happen, but some injuries can be avoided with proper precautions. A person should wear protective gear when playing sports, use proper lifting techniques, and avoid lifting objects that are too heavy.

Maintaining good posture. A person should be mindful of keeping the back straight when sitting, standing, and walking.

Quitting or not starting smoking. Smoking is harmful to the body’s tissues and bones.

Eating a healthful diet. A balanced diet of fruits, vegetables, whole grains, and lean protein contains nutrients that the bones and joints need.

Trying supplements. Some people may benefit from calcium or vitamin D supplements to keep bones healthy. People should always discuss supplements with a doctor before taking them.

FAQ's

Can facet arthropathy lead to other conditions?

Facet arthropathy can contribute to the development of bone spurs and spinal stenosis.

What is the outlook for facet arthropathy?

Those experiencing pain from facet arthropathy usually respond well to forms of physical therapy. More progressed stages of this condition may require minimally invasive procedures or surgery, but pain relief is still possible.

Does facet arthropathy require surgery?

Facet arthropathy may require surgery if other forms of treatment or physical therapy are not successful at alleviating lower back pain. Noninvasive or minimally-invasive techniques can be attempted before surgery.

Can a pain doctor help alleviate facet arthropathy?

Pain management doctors may help alleviate pain from facet arthropathy by recommending stretches and exercises of the lower back. In certain cases, medication and surgery may be required.

Outlook

Unfortunately, the facet joints cannot heal once they become damaged. This does not mean, however, that there is no chance for relief.

Many treatment options exist to help manage the pain of facet arthropathy, including medications and physical therapy.

Working with a healthcare professional and following an individualized treatment plan can increase the chance of leading a healthier, more active life.

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Most recent revision June 12, 2025 09:28:38 PM