Overview
Spinal arthritis, also referred to as facet joint arthropathy, is a degenerative condition affecting the facet joints—the small stabilizing joints located at each level of the spine. These joints can become inflamed and arthritic over time, leading to chronic spinal pain, stiffness, and reduced mobility.
Facet arthritis most commonly occurs in the cervical (neck) and lumbar (lower back) regions and is a frequent contributor to axial spine pain, especially in older adults.
Common Causes
Age-related degeneration – Normal wear and tear leads to cartilage loss and joint inflammation.
Repetitive stress or trauma – Chronic mechanical loading from heavy lifting or poor posture.
Spinal instability – Abnormal motion increases joint stress.
Degenerative disc disease – Loss of disc height puts added pressure on facet joints.
Previous spinal surgery or injury
Inflammatory arthritis (e.g., rheumatoid arthritis, ankylosing spondylitis) in rare cases
Symptoms
Localized neck or back pain near the spine
Stiffness, especially in the morning or after prolonged inactivity
Pain worsened by extension, twisting, or prolonged standing
Tenderness over the facet joints on palpation
Referred pain to shoulders, upper back, buttocks, or thighs
Usually no significant leg or arm numbness, unless other pathologies are involved
Treatment Options
Conservative Treatments
Physical therapy – Focus on spinal stabilization, flexibility, and posture correction
Anti-inflammatory medications (NSAIDs) – For pain and inflammation
Activity modification – Avoiding repetitive strain and improving ergonomics
Manual therapy and massage
Weight loss – To reduce axial load on the spine
Interventional Pain Management Options
When conservative measures fail to provide adequate relief, targeted interventional procedures may be effective:
Medial Branch Nerve Blocks (MBB)
Diagnostic injections that temporarily block the nerves transmitting pain from the facet joints. Useful to confirm the diagnosis of facet-mediated pain.
Radiofrequency Ablation (RFA)
If pain relief is achieved with MBB, RFA may be performed to thermally ablate the medial branch nerves, providing longer-lasting relief (typically 6–18 months).
Intra-articular Facet Joint Injections
Corticosteroids are injected directly into the facet joint to reduce inflammation—more commonly used for acute flare-ups.
Endoscopic Rhizotomy
A minimally invasive technique to visually identify and ablate the medial branch nerves with enhanced precision, often offering longer relief than traditional RFA.
Regenerative Injections (e.g., PRP or BMAC)
May be used in select cases to reduce inflammation and support joint healing, though evidence is still evolving.
Surgical Options
Surgery is rarely needed solely for facet arthritis, but may be considered in cases with associated:
Severe spinal stenosis
Instability requiring fusion surgery
Failed conservative and interventional treatments
Conclusion
Spinal arthritis due to facet joint degeneration is a common and often underdiagnosed source of axial spine pain. A stepwise approach—starting with conservative care and escalating to minimally invasive interventional procedures like medial branch blocks and radiofrequency ablation—can provide effective, long-term relief and help patients return to a more active, functional lifestyle.