Facet Joint Arthropathy

Facet joint arthropathy is arthritis in the small joints at the back of your spine. At every spinal level, two small paired joints (the facet joints) link one vertebra to the next and guide how your back bends and twists. Like any joint, the facets can wear out — losing cartilage, growing bony spurs, and getting inflamed. It's an extremely common cause of neck or back pain along the midline (rather than radiating into a limb), especially in older adults.

Facet pain has a distinctive pattern: worse when you arch backward or twist, eased when you lean forward. The pain can spread to the shoulder or buttock (this is referred pain — different from a pinched nerve, which radiates further down the limb). The diagnosis is confirmed when a small numbing injection into the nerves that supply those facets temporarily relieves the pain.

Facet pain is typically a deep ache right along the midline of your lower back or neck — not the shooting, electric sensation of a pinched nerve. It gets worse when you arch backward, twist, or stand for a long time, and tends to ease when you lean forward. The pain can spread into your buttock (from lumbar facets) or your shoulder blade area (from cervical facets), but it rarely travels below the knee or past the elbow.

Morning stiffness is common — your back feels locked up for the first few minutes, then loosens with gentle movement. Flares often follow sustained postures: a long car ride, sleeping on your stomach, or any activity that loads the spine in extension. Unlike a disc herniation, coughing and sneezing don't usually make facet pain worse.

X-rays and CT show enlarged, thickened facet joints. MRI shows fluid-filled cysts at the facets and thickening of the ligaments inside the canal. But imaging alone doesn't reliably tell who has facet pain — many people have arthritic-looking facets without symptoms. The gold standard is two separate medial branch nerve blocks (small numbing injections, guided by live X-ray) on different days; if both give substantial relief, the facets are confirmed as the pain source.

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.

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

• Britannica — Vertebral column
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language