Facet Joint Arthropathy

Facet joint arthropathy is a degenerative condition affecting the zygapophyseal (facet) joints of the spine, often contributing to chronic axial pain, especially in the cervical and lumbar regions.

Facet joints are synovial joints prone to wear and tear due to repetitive mechanical stress and age-related degeneration. Arthropathy involves:

• Cartilage degeneration
• Subchondral bone sclerosis
• Osteophyte formation
• Joint space narrowing
• Synovial inflammation

These changes lead to nociceptive pain from the richly innervated joint capsule and surrounding structures.

• Axial pain (neck or low back)
• Worse with extension, rotation, prolonged standing
• May mimic radiculopathy but without dermatomal distribution
• Pain often improves with flexion or sitting

• Localized paraspinal tenderness
• Pain reproduced with extension/rotation

• Medial branch block (MBB) – anesthetic near the medial branch nerves
• Intra-articular injection – direct steroid/anesthetic into the facet joint
• Positive response supports diagnosis

• NSAIDs
• Physical therapy (core strengthening, posture)
• Activity modification

• MBB (diagnostic and therapeutic)
• Intra-articular steroid injection
• Radiofrequency ablation (RFA) – long-lasting denervation of medial branches

• Rarely needed
• Consider facet resection or spinal fusion in unstable or refractory cases

• Common source of axial spinal pain in adults
• Often underdiagnosed; imaging alone may be insufficient
• SPECT/CT can identify active facet joint involvement
• RFA provides long-term relief in selected patients