Facet arthropathy is arthritis in the small paired joints at the back of the spine. Almost everyone has some past middle age.
In more detail
- The facet joints are true synovial joints (joints with a lining that makes lubricating fluid, like knees and hips). Like knees and hips, they develop wear, cartilage loss, bone spurs and joint enlargement.
- ‘Arthropathy’, ‘facet hypertrophy’, ‘facet degenerative change’ and ‘facet arthrosis’ all describe the same process.
- It is so common on imaging that seeing it on a report proves very little about the source of your pain.
What it means for you
Facet joints truly can cause pain. It is usually on one side. It gets worse when you lean back or twist. It can spread to the buttock or shoulder blade but rarely past the knee. Whether yours are the source is found by medial branch block, not by the scan. Where blocks confirm it, radiofrequency ablation can give many months of relief.
Remember the general rule. Findings like this one are common in people with no pain at all. They become steadily more common with age. A finding on a report is not a diagnosis until someone has matched it to your symptoms and your exam. See understanding your MRI report.
Bring your scan and report in and we will go through it with you. Call us or request an appointment.
How common is it, and what does it predict?
Facet arthropathy is degenerative change (the joint breaking down) in the small paired joints at the back of each spine segment. It means thinning cartilage, a narrower joint space, bone spurs and a thicker joint capsule (the joint’s outer covering). Almost everyone has it past middle age. It shows up all the time in reports for people with no back pain. The key point: the finding cannot show that those joints are your pain source. That is what a medial branch block tests. The reason two blocks are standard before ablation is that a single block gives a false positive (a wrong yes) often enough to matter.
Common questions
Does facet arthropathy mean I will end up disabled?
No. It is a very common imaging finding, and most people who have it do well.
That is the subject of Understanding Your MRI Report.
Why can’t the MRI tell you if my facets are the problem?
Because degeneration is present in most adults, with or without pain. Only a targeted diagnostic block answers it.
Understanding Your MRI Report explains what that looks like.
If my facets are arthritic, is that my pain?
The scan cannot tell. Facet degeneration is present in most adults. A diagnostic block is what answers it.
The mechanism is covered in Facet Joint Pain.
What does facet pain feel like?
It is usually worse when you lean back or twist, and better when you bend forward. It sits just to one side of the spine, not in the middle of the back.
See Facet Joint Pain.
What is the next step if this is suspected?
A medial branch block, which tests whether those joints cause your pain. Where two blocks agree, ablation of the same nerves becomes a sound option.
The block itself is explained in Medial Branch Block.
Sources
- Brinjikji W et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American journal of neuroradiology, 2015. PubMed 25430861
- Cohen SP et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Regional anesthesia and pain medicine, 2020. PubMed 32245841
- Du R et al. Facet Joint Syndrome: Pathophysiology, Diagnosis, and Treatment. Journal of pain research, 2022. PubMed 36474960
- Bezuglov E et al. Asymptomatic Degenerative Changes in the Lumbar Spine Among Professional Soccer Players. Spine, 2021. PubMed 33347092
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