Facet Joint Arthropathy
Facet joint arthropathy — also called zygapophyseal joint arthropathy or facet syndrome — is a degenerative condition of the small paired joints at the back of each spinal level that is responsible for approximately 10–15% of chronic low back pain and a similar proportion of chronic neck pain. Because no clinical examination finding reliably distinguishes facet pain from other sources of spinal pain, precise diagnosis requires a targeted diagnostic injection procedure known as a medial branch block. At Maryland Orthopedic Specialists, we are experienced in both the diagnostic and therapeutic aspects of facet joint pain management, including medial branch blocks and radiofrequency ablation — a procedure that provides 6–12 months of durable relief in well-selected patients.
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What is facet joint arthropathy?
The zygapophyseal (facet) joints are paired synovial joints located at the posterior elements of every spinal level from C2–C3 through L5–S1. Their articular surfaces are covered with hyaline cartilage and the joint is enclosed in a fibrous capsule with a synovial lining.
The zygapophyseal (facet) joints are paired synovial joints located at the posterior elements of every spinal level from C2–C3 through L5–S1. Their articular surfaces are covered with hyaline cartilage and the joint is enclosed in a fibrous capsule with a synovial lining. Each facet joint is innervated by the medial branches of the dorsal rami at that level and the level above — a fact that is the anatomical basis for medial branch block and RFA treatment.
Facet joints guide and constrain spinal motion while resisting torsion and extension forces. With age, disc height loss shifts mechanical load posteriorly onto the facet joints, accelerating cartilage wear, synovial inflammation, capsular hypertrophy, and osteophyte formation — the same degenerative process seen in peripheral joint osteoarthritis. Facet joint hypertrophy can contribute to foraminal and central canal stenosis when severe.
Prevalence: Lumbar facet joints are estimated to be the primary pain source in 15–45% of chronic low back pain cases (with wide variation by study population). Cervical facet joints are implicated in 36–67% of chronic neck pain, including post-whiplash chronic neck pain.
Treatment options
Treatment starts with physical therapy and activity modification, progressing to targeted injections when conservative care is insufficient.
Physical Therapy
Lumbar stabilization, hip and gluteal strengthening, and postural training reduce mechanical stress on the facet joints and are the foundation of non-operative care. Extension-limiting strategies — such as avoiding prolonged standing and lumbar hyperextension — offload the posterior spine where the facet joints live. Body weight management further reduces chronic loading on these joints.
Medications
NSAIDs manage inflammatory flares and are the primary medication for facet joint pain. Topical anti-inflammatories are a useful option for patients who cannot tolerate oral medications or have other health conditions that limit NSAID use.
Medial Branch Block
A medial branch block is a diagnostic injection of local anesthetic along the small nerves that supply the facet joints — it is primarily used to confirm that the facet joint is the source of pain. If the injection relieves pain by 50–80%, it confirms the facet as the pain generator and qualifies the patient for radiofrequency ablation. The procedure is performed under fluoroscopic guidance and takes only a few minutes.
Radiofrequency Ablation (RFA)
RFA is a minimally invasive procedure that uses carefully controlled heat to interrupt the pain signal from the facet joint nerves, providing relief that lasts 6 to 18 months on average. Most patients notice progressive improvement in the weeks following the procedure as the treated nerves fully degenerate. When pain returns as the nerves regenerate, the procedure can be safely repeated with consistent results.
Frequently Asked Questions
How is a medial branch block different from a facet joint injection?
Does RFA permanently damage the nerve?
What does RFA feel like after the procedure?
Is the 50% pain relief threshold for a positive block strict?
Can facet arthropathy cause leg pain?
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References
- Bogduk N, MacVicar J, Borowczyk J. "The pain of cervical disc herniations and the effects of cervical medial branch blocks." Pain Medicine 2013;14(5):720–724. https://doi.org/10.1111/pme.12074
- Cohen SP, Huang JHY, Brummett C. "Facet joint pain — advances in patient selection and treatment." Nature Reviews Rheumatology 2013;9(2):101–116. https://doi.org/10.1038/nrrheum.2012.198
- Manchikanti L, Abdi S, Atluri S, et al. "An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain." Pain Physician 2013;16(2 Suppl):S49–S283. PMID: 23615883
- Dreyfuss P, Halbrook B, Pauza K, Joshi A, McLarty J, Bogduk N. "Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain." Spine 2000;25(10):1270–1277. https://doi.org/10.1097/00007632-200005150-00012
- Barnsley L, Lord SM, Wallis BJ, Bogduk N. "Lack of effect of intraarticular corticosteroids for chronic pain in the cervical zygapophyseal joints." New England Journal of Medicine 1994;330(15):1047–1050. https://doi.org/10.1056/NEJM199404143301504
- OrthoInfo / AAOS. "Lumbar (Spinal) Stenosis." https://orthoinfo.aaos.org/en/diseases--conditions/spinal-stenosis/