What is Facet Joint Disease?
Arthritis of the small paired joints at the back of the spine facet joints. A common source of axial back or neck pain, often coexisting with disc degeneration.
Causes
Age-related wear and arthritis of the facet joints, often combined with loss of disc height that loads the joints unevenly. Repetitive extension and rotation of the spine contribute.
Symptoms
Aching pain in the back or neck, typically worse with extension leaning back and rotation, often worse first thing in the morning and eased by gentle movement. The pain is usually axial and localised, but can refer into the buttock, groin or thigh lumbar or into the head and shoulder cervical.
Diagnosis
Clinical history and examination — the pattern of extension-rotation pain is characteristic. Diagnostic medial branch blocks a small injection of local anaesthetic around the tiny nerve that supplies a facet joint are used to confirm whether a specific facet joint is producing pain before considering radiofrequency ablation.
Imaging
X-ray, MRI or CT showing facet joint arthritis joint-space narrowing, hypertrophy, subchondral changes, cysts. MRI also shows associated disc and ligament changes. As with other degenerative findings, imaging must be interpreted alongside symptoms.
Treatment
Non-surgical care activity, structured physiotherapy core, postural and aerobic work, medications paracetamol, NSAIDs and adjuncts, and image-guided facet joint steroid injections. Where a diagnostic medial branch block is helpful, radiofrequency ablation can be used to deactivate the small nerves supplying the joint, typically giving 6–18 months of relief. Fusion surgery is rarely indicated solely for facet pain.