How Is Facet Arthropathy Treated?

Facet arthropathy is a type of wear-and-tear arthritis that affects the spine. Facet joints are found between the bony protrusions on the back of the vertebrae that form your backbone. Osteoarthritis that develops there causes pain and stiffness in the neck and lower back.

Facet joint osteoarthritis, or 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.

This article discusses facet arthropathy. It explains what facet joints are and how they develop osteoarthritis. It also details the symptoms, diagnosis, and treatment of facet arthropathy.

Causes of Facet Athropathy
Verywell / Gary Ferster

What Are Facet Joints?

Facet joints are found in the posterior of the spine. There are 24 vertebrae that form the human spine above the sacrum (tailbone). There are two facet joints between the vertebrae of each spinal segment along the spinal column.

The facet joints and intervertebral disc form a three-joint complex between adjacent vertebrae. A facet joint has two bony surfaces with cartilage between them and a capsule of ligaments surrounding it.

Synovial fluid lubricates the joints, as is the case with other joints such as the knee. Facet joints help keep the normal alignment of the vertebrae and limit motion.

Facet Arthropathy Symptoms

Pain is the main symptom associated with facet arthropathy. The pain is typically worse in the afternoon and evening, and upon waking in the morning. Pain associated with facet arthropathy may be exacerbated by twisting or bending backward.

Low back pain is the most frequent complaint, but it does not typically radiate down the legs or buttocks unless spinal stenosis is also involved.

Causes

Facet arthropathy is degenerative arthritis which affects the facet joints of the spine. Arthritis in the facet joints can develop from:

  • Wear and tear that decreases space between vertebrae causing facet joints to rub together
  • A previous back injury
  • Fractures
  • Torn ligaments
  • Disc problems

Due to the additional stress caused by these circumstances affecting the facet joints, bone spurs (also known as osteophytes) can develop and cartilage can deteriorate.

Other than due to injuries, facet arthropathy is a condition of aging. The primary cause of facet arthropathy is spinal degeneration which typically occurs in later life.

Diagnosis

X-rays, computerized tomography (CT) scans, and magnetic resonance imaging (MRI) may be used to help diagnose facet arthropathy.

Another procedure that is more specific involves performing a guided injection using a fluoroscope. Medicine and dye are injected. The dye allows the healthcare provider to view the placement of the needle and injection. If the facet joint is injected and pain relief is the result, that serves to confirm the diagnosis of facet arthropathy.

Treatment

Initially, the healthcare provider may recommend a period of rest in an effort to tame the symptoms. Sleep positions that take the pressure off of facet joints may be recommended, such as curling up to sleep or lying on your back with knees up and pillow underneath.

Oral medication may be prescribed, including:

  • Tylenol (acetaminophen)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Muscle relaxants
  • Corticosteroids

Other treatment options include:

  • Traction
  • Strengthening and aerobic exercise
  • Water therapy
  • Spinal manipulation

Aggressive Treatments

If conservative measures fail, your healthcare provider may recommend these treatments:

  • Injections of an anesthetic or steroid medicine into the facet joint or nerves that go to the facet joint may be tried.
  • Sinu-vertebral nerve ablation which destroys nerves with electrical current may be an option.

Surgical Options

Surgical options to treat facet arthropathy include:

  • Facet rhizotomy: Sever one of the nerves going to facet joint.
  • Fusion: Fuse two or more vertebrae to eliminate movement in facet joints. Sometimes facet joints are removed during spinal fusion.

Frequently Asked Questions

  • What is the difference between arthropathy and arthrosis?

    Arthropathy refers to any type of disease affecting a joint, such as arthritis. These are often associated with joint swelling, stiffness, and a reduced range of motion. Arthrosis is another name used for osteoarthritis (OA), a different type of arthropathy. OA can cause joint instability, joint pain or tenderness, and sensations of joint cracking, grinding, or popping, among other symptoms.

  • What is lumbar facet arthropathy?

    Lumbar facet arthropathy is osteoarthritis that causes lower back pain, specifically in the lumbar spine. People age 65 and older are the most at risk, but lumbar facet arthropathy can affect anyone. There is also an increased risk for people with a high body mass index (BMI).

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Orthopaedic Surgeons, Spinal injections

  2. Johns Hopkins Medicine. Arthropathy.

  3. Mann SJ, Viswanath O, Singh P. Lumbar Facet Arthropathy. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.

Additional Reading
  • Firestein, Gary S.; Budd, Ralph; Gabriel, Sherine E; ODell, James R; McInnes, Iain B, Budd RC, Firestein GS, Kelley WN. Kelleys Textbook of Rheumatology. Elsevier Health Sciences; 2012.

By Carol Eustice
Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis.