Spine · Non-operative care

Facet Joint Arthropathy

Most spine pain never needs surgery. OSI evaluates you, orders imaging only when it will actually change the plan, and walks you through the non-operative care that handles the vast majority of spine problems — activity guidance, physical therapy, medications, and targeted injections.

Overview

what it is and why it matters
Labeled diagram of the vertebral column: cervical, thoracic, lumbar, sacral, and coccygeal segments with intervertebral discs.
Spine anatomy. The spinal column has 33 vertebrae grouped into the neck (cervical), upper back (thoracic), lower back (lumbar), sacrum, and tailbone. Soft intervertebral discs sit between each pair of vertebrae as cushions; the spinal cord and its nerve roots run through the hollow canal at the back.
OpenStax Anatomy & Physiology · Public Domain

Facet joint arthropathy is degenerative arthritis affecting the zygapophyseal (facet) joints of the spine, which guide and limit spinal motion at each level. Like any synovial joint, facets can develop cartilage loss, osteophyte formation, joint space narrowing, and synovitis. It is an extremely common cause of axial neck or back pain — especially in older adults.

Facet-mediated pain is typically worse with extension and rotation, eased by forward flexion, and may radiate to the shoulder or buttock (referred pain, not radiculopathy). The diagnosis is confirmed by response to medial branch nerve blocks.

Diagnosis

exam first, imaging second

X-rays and CT show facet joint hypertrophy and sclerosis. MRI demonstrates synovial cysts and ligamentum flavum thickening. However, imaging findings do not reliably predict who has facet pain — diagnostic medial branch nerve blocks (controlled, fluoroscopy-guided) are the gold standard for confirming facet-mediated pain before ablation.

Treatment Path

how care progresses at OSI
1

Physical therapy

Extension and rotation exercises, core stabilization.

2

NSAIDs

For acute flares.

3

Facet intra-articular injection

Corticosteroid injected into the facet joint.

  1. Medial branch nerve block

    Diagnostic local anesthetic block; if two controlled blocks give >80% relief, the patient is a candidate for ablation.

  2. Radiofrequency ablation (RFA)

    The medial branch nerves supplying the arthritic facets are ablated with radiofrequency energy, providing 12–18+ months of relief. Repeatable as nerves regenerate.

If Surgery Is Truly Needed

rare for most patients

Surgery helps only a small minority of spine patients — usually those with a specific structural problem plus a nerve issue that isn’t getting better with a structured non-operative trial. When that step is genuinely warranted, OSI coordinates it the same way we coordinate every other part of your care: imaging, records, and the handoff are handled for you, so no part of the process falls on your shoulders.

Further Reading

authoritative sources

External patient-education references and related OSI pages for additional background:

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