Facet arthritis

Osteoarthritis (degenerative arthritis) is due to the wearing away of cartilage between the facet joints. When the joints move, the lack of the cartilage causes pain as well as loss of motion and stiffness.

The spine consists of a stack of vertebrae that interact with each other. In front the vertebrae are separated from each other by spongy discs. In back the vertebrae are separated from each other by facet joints. The facet joints are located in the back portion (posterior) of the spine. The joints combine with the disc space to create a three-joint complex at each vertebral level. The facet joint consists of two opposing bony surfaces with cartilage between them and a capsule around it. The joint also has fluid lubricating the joint.

The combination of the cartilage and the fluid allows the joint to move with little friction. However, facet joint arthritis is due to cartilage breakdown; joint movement is associated with more friction. In addition, as the facet joint becomes more arthritis, it enlarges often leading to irritation of nearby nerve roots. This situation leads to muscle spasm and pain.

Facet arthritis is most common in the low back and neck where more movement occurs.

Typically, the back pain is most pronounced first thing in the morning. Throughout the day, normal movement causes a “loosening up” in the joint and there is usually less pain. Later in the day the pain typically becomes worse again as more stress is applied across the joint.

Conservative treatments that concentrate on maintaining motion in the back are most effective for relieving the pain.

• Stretching exercises for the hamstring muscles, hip joints, and the back can usually serve to prevent the pain from getting worse.
• For more severe pain, chiropractic or osteopathic manipulations can help relieve pain.
• Water therapy can be also be helpful since the joints are un weighted in the water and do not generate as much pain when being moved.
• Acetaminophen is an effective and relatively safe non-prescription medication to help alleviate the pain, and some patients find NSAID's to be helpful.
• Physical therapy modalities such as ultrasound, traction, and electrical stimulation are helpful
• Facet block injections consisting of specially guided injections into the facet joint can also be of value


The only effective surgical treatment option is a fusion to stop the motion at the painful joint, but this surgery is generally not recommended since multiple vertebral levels tend to be affected by osteoarthritis and multilevel fusions are generally not advisable.

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