Facet Joint Osteoarthritis

By: Peter F. Ullrich, Jr., MD
March 15, 2001

Osteoarthritis (degenerative arthritis) can cause breakdown of cartilage between the facet joints. When the joints move, the lack of the cartilage causes pain as well as loss of motion and stiffness.

The facet joints are located in the back portion (posterior) of the spine. The joints combine with the disc space to create a three-joint complex at each vertebral level. The facet joint consists of two opposing bony surfaces with cartilage between them and a capsule around it. The joint also has fluid lubricating the joint.

The combination of the cartilage and the fluid allows the joint to move with little friction. However, facet joint arthritis causes the cartilage to breakdown and the joint movement is associated with more friction. The patient loses motion and as they get stiffer they have more back pain.

Typically, the low back pain is most pronounced first thing in the morning. Throughout the day, normal movement causes fluid to build up in the joint and it becomes better lubricated, which decreases the pain. Later in the day the pain typically becomes worse again as more stress is applied across the joint.

Treatment options

• Stretching exercises for the hamstring muscles, hip joints, and the back can usually serve to prevent the pain from getting worse.

• For more severe pain, chiropractic or osteopathic manipulations can help relieve pain.

• Water therapy can be also be helpful since the joints are unweighted in the water and do not generate as much pain when being moved.

• Acetaminophen is an effective and relatively safe non-prescription medication to help alleviate the pain, and some patients find NSAID's to be helpful.

The only effective surgical treatment option is a fusion to stop the motion at the painful joint, but this surgery is generally not recommended since multiple vertebral levels tend to be affected by osteoarthritis and multilevel fusions are generally not advisable.

Peter F. Ullrich, Jr., MD
March 15, 2001