What is facet joint syndrome?
Running down the back of your spine are pairs of small, smooth joints - the facet joints - that link each vertebra to the ones above and below. They guide and steady the spine as you bend, twist, and lean back. Facet joint syndrome (also called facet joint pain, facet arthropathy, or facet joint osteoarthritis) is pain that comes from these joints when the protective cartilage wears down and they become inflamed.
It can occur anywhere along the spine, but it is most common in the lower back (lumbar) and the neck (cervical). The pain is usually felt close to the spine itself, and it often eases when you rest and flares when you move in certain ways.
The reassuring part: facet joint pain is a mechanical, wear-related problem, and most people improve with non-surgical care. Our role is to confirm the joint is truly the source and guide you to the least invasive treatment that gives lasting relief.
Symptoms to look for
Facet pain tends to follow a recognizable pattern:
- Localised, dull ache near the spine - in the lower back, or in the neck and shoulders - rather than pain that shoots far down a limb.
- Worse bending backwards or twisting, and often when standing or after long periods held still.
- Morning stiffness that tends to ease once you get moving.
- Tenderness when the area over the joint is pressed.
- Referred pain - lumbar facets can ache into the buttock or thigh, and neck facets can refer into the shoulder or trigger headaches.
Symptoms can come and go in flares. A careful examination - not the scan alone - is what tells us whether the facet joints are the real source.
NOTE
Facet joint pain is not usually an emergency. But if back or neck pain follows a significant injury, or comes with fever, unexplained weight loss, or pain that travels down a limb with numbness or weakness, see a doctor promptly so other causes can be ruled out.
What causes facet joint syndrome?
Most facet joint pain is down to gradual wear. As the cartilage cushioning each joint thins with age, the joint surfaces rub, inflame, and can form bone spurs - the same osteoarthritis process seen in other joints. It becomes more common from the mid-40s onward. Long hours at a desk, repeated bending and twisting, carrying extra weight, physically demanding work, and previous spine injury or surgery can all add to the load. Wear in the nearby discs often goes hand in hand with facet strain, because the two share the work of supporting each segment of the spine.
How we diagnose it
Diagnosis begins with your history and a focused examination - checking which movements bring the pain on and where it is felt. Imaging such as X-ray, CT, or MRI can show joint wear and help rule out other causes.
Because joint changes are common on scans and do not always cause pain, imaging alone cannot confirm the source. Where the picture is unclear, a diagnostic facet joint injection - placing a small amount of local anesthetic around the joint - can help confirm whether it is driving your pain. We match the findings to your symptoms and treat the person, not the scan. Your assessment is led by a US board-certified neurosurgeon.
Treatment - least invasive first
We follow a measured, surgery-last approach, starting with the simplest options that can give durable relief.
- Conservative care (first line for most). Staying gently active, activity and posture adjustments, and short-term anti-inflammatory medication often settle a flare.
- Physiotherapy. A guided program to strengthen the muscles supporting the spine, improve movement, and ease load through the joints.
- Facet injections and radiofrequency ablation. If pain persists, an image-guided facet injection can calm inflammation, and radiofrequency ablation (rhizotomy) can quieten the small nerves carrying pain from the joint, often giving relief that lasts several months to a year or more.
- Endoscopic options (when warranted). In selected cases, an endoscopic foraminotomy or rhizotomy uses a small camera through a tiny, muscle-sparing incision to treat the nerves involved. Surgery is uncommon for facet pain alone and is considered only when simpler measures have not helped.
If you have already been told you need surgery, we are glad to give an honest second opinion on whether a less invasive path could work for you.
What to expect
Many flares of facet joint pain settle over a few weeks with activity changes and physiotherapy. Because it is a wear-related condition, the aim is often to manage symptoms and keep them from returning rather than to ‘fix’ the joint completely. If you have an injection or radiofrequency ablation, relief can last from several months to over a year, and the treatment can usually be repeated if needed. Your surgeon will explain the likely timeline for your specific case, and the plan is built around you, with clear explanations at every step.
Common questions
What does facet joint pain feel like?
Facet joint pain is usually a dull, localised ache close to the spine - in the lower back or the neck - rather than pain that shoots far down a limb. It often worsens when you bend backwards, twist, or stand for a while, and eases with rest. Some people also notice morning stiffness and tenderness over the joint.
What makes facet joint pain worse?
Movements that load or close the joints tend to aggravate facet pain - bending backwards, twisting, standing for long periods, and getting up after sitting still. Symptoms often flare after activity and settle with rest. Poor posture and long hours at a desk can add to the strain, which is why gentle movement and posture changes usually help.
Can facet joint syndrome be treated without surgery?
Usually, yes. Most facet joint pain improves with non-surgical care - staying active, physiotherapy, posture changes, and short-term anti-inflammatory medication. If pain persists, image-guided facet injections or radiofrequency ablation can calm the joint. Surgery is uncommon for facet pain alone and is considered only when simpler measures have not helped.
How long does radiofrequency ablation for facet joints last?
Radiofrequency ablation quietens the small nerves that carry pain from a facet joint, and relief commonly lasts from several months up to a year or more. The nerves can gradually regrow, so pain may return over time, and the treatment can usually be repeated. Your specialist can explain what to expect for your situation.
Does facet joint syndrome go away on its own?
Individual flares often settle within a few weeks with gentle activity and physiotherapy. Because facet joint syndrome is a wear-related, arthritis-type condition, the underlying joint changes tend to remain, so the aim is usually to control symptoms and reduce flares rather than reverse the joint completely. Many people manage well without surgery.
Is facet joint syndrome serious?
Facet joint syndrome is a common, mechanical cause of back or neck pain and is not usually dangerous. It can be uncomfortable and persistent, but it rarely signals an emergency. See a doctor promptly if pain follows a significant injury, or comes with fever, unexplained weight loss, or numbness or weakness in a limb.