Facet Joint Syndrome

What are the facet joints?

Each vertebra connects to the ones above and below at three points: the disc in front and two facet joints behind (one on each side). Facet joints are small synovial joints with cartilage, a lining and a capsule, like a knuckle. They guide and limit movement, stopping the spine from twisting or bending too far, and they carry more load when you arch backward or when the disc in front has lost height.

Each joint is supplied by two small nerves called medial branches. These nerves are the target of the diagnostic blocks and ablation treatments described below.

Symptoms of facet joint syndrome

Lumbar (low back) facet pain

• Dull, deep ache on one or both sides of the low back
• Pain that can spread to the buttock, hip or back of the thigh, usually stopping above the knee
• Worse with leaning backward, twisting, standing still for a long time, or getting up from a chair
• Eased by bending forward, sitting, or leaning on a shopping cart
• Morning stiffness that loosens after you start moving
• Tenderness when pressing over the affected joint

Cervical (neck) facet pain

• Aching on one side of the neck, often after whiplash
• Pain referred to the back of the head, top of the shoulder or between the shoulder blades, depending on the level
• Pain and stiffness turning the head or looking up

Facet pain does not usually cause true numbness, pins and needles or weakness. Those point toward a pinched nerve root, as in sciatica or spinal stenosis. An enlarged facet joint or a synovial cyst growing from it can narrow the canal and cause both.

Causes and risk factors

• Osteoarthritis: the main cause. Facet joints wear like any other joint, losing cartilage and forming bone spurs. This is part of spondylosis, the general aging of the spine.
• Disc degeneration: when a disc loses height, more weight shifts onto the facets behind it. Degenerative disc disease and facet arthritis often occur together.
• Injury: whiplash in the neck, or sudden twisting or lifting in the low back, can sprain the capsule.
• Spondylolisthesis: a slipped vertebra stresses the facets.
• Other factors: age over 50, excess body weight, jobs with repeated twisting or arching, and inflammatory arthritis.

Facet pain vs other causes of back pain

Many people have more than one source of pain, which is why tests are needed. Read about sacroiliac joint dysfunction if your pain sits lower, at the back of the pelvis.

How facet joint syndrome is diagnosed

1. History and exam: the doctor looks for pain on extension and rotation, tenderness over the joints, and normal nerve function in the legs or arms.
2. Imaging: X-rays, CT or MRI show joint narrowing, bone spurs and fluid in the joints. Facet arthritis is very common on scans of people with no pain, so imaging alone cannot prove the joints are the source.
3. Medial branch blocks: under X-ray guidance, a small amount of local anesthetic is placed on the nerves supplying the suspected joints. If your usual pain drops by at least half (often 80% is required) for the hours the anesthetic lasts, the facets are the likely cause. Two blocks are often done to confirm.
4. Intra-articular facet injection: anesthetic, sometimes with steroid, injected into the joint itself. It is used both to diagnose and to treat.

Treatment

First-line care

• Stay active. Bed rest slows recovery.
• Physical therapy: core and hip strengthening, flexion-based exercises, posture work and gradual return to activity.
• Medicines: NSAIDs at the label dose for short periods (avoid with stomach ulcers, kidney disease or blood thinners). Acetaminophen (paracetamol) alone helps little for back pain. Muscle relaxants are sometimes used briefly.
• Heat before activity and ice after flares.
• Weight loss if needed, to reduce load.

Injections

Steroid injections into the facet joint give variable and often short-lived relief and are not recommended by all guidelines for long-term use.

Radiofrequency ablation

Radiofrequency ablation (RFA), also called rhizotomy or neurotomy, heats the medial branch nerves with a needle probe so they stop sending pain signals from the joint. It is offered after positive diagnostic blocks. Relief typically lasts 6 to 12 months or longer, until the nerves regrow, and the procedure can be repeated.

Surgery

Surgery is rarely done for facet pain alone. Spinal fusion or decompression may be considered when facet disease causes instability, spondylolisthesis or nerve compression.

Outlook and prevention

Most flares settle within weeks. Facet arthritis itself is permanent and tends to recur, but regular exercise, core strength, a healthy weight, frequent position changes and good lifting technique keep many people active with little pain. RFA helps a large share of people whose pain persists.

Frequently asked questions

What does facet joint pain feel like?

It is usually a deep, dull ache beside the spine that is worse when you lean back, twist or stand for a long time, and better when you sit or bend forward. It may spread into the buttock, thigh or shoulder but rarely below the knee, and it often comes with morning stiffness.

Is facet joint syndrome serious?

Usually not. It is a common mechanical cause of back and neck pain and does not damage nerves or the spinal cord by itself. It can be persistent and frustrating, but most people manage it well with exercise and pain relief. Red flags such as leg weakness or bladder changes need urgent assessment.

How is facet joint syndrome confirmed?

Scans show arthritis but cannot prove it causes the pain. The most reliable test is a medial branch block, an injection of local anesthetic onto the small nerves supplying the joint. A large, short-term drop in your usual pain confirms the facet joints as the source.

Can facet joint pain go away on its own?

Flares often settle on their own within a few weeks, especially with gentle movement and exercise. The underlying arthritis does not disappear, so pain may return with strain or long periods of standing. Ongoing strengthening exercise reduces how often and how badly it returns.

How long does radiofrequency ablation last for facet joints?

Relief usually lasts from about 6 months to more than a year. The treated nerves slowly regrow, and pain can return. If the first procedure worked well, it can be repeated with similar benefit.