Arthrosis of the spine is the gradual wearing down of the small joints that connect your vertebrae, called facet joints. It’s the same process as osteoarthritis in a knee or hip, just happening in your back or neck. These facet joints are the only true synovial (fluid-lined) joints between each level of your spine, and they bear a surprising amount of load every time you bend, twist, or simply stand upright. The condition becomes increasingly common with age: roughly 23% of adults between 55 and 64 have osteoarthritis, rising to about 34% of those 75 and older.
How Spinal Arthrosis Develops
Each spinal “motion segment” includes two facet joints in the back and a disc in the front. These structures work as a team, so when one starts to break down, the others follow. In most cases, the disc loses height first. That shifts extra stress onto the facet joints behind it, accelerating cartilage loss. As the cartilage thins, the joint space narrows, the surrounding bone thickens and hardens (a process called sclerosis), and bony spurs form along the joint margins. High-grade cartilage breakdown in facet joints can happen relatively quickly compared to other joints in the body.
Inflammation plays a direct role in pain. As the joint degenerates, the synovial lining becomes actively inflamed, and the bone beneath the cartilage can develop swelling visible on MRI. This inflammatory process irritates nearby nerves and generates the local pain people feel in their back or neck. Over time, the joint can remodel so much that one vertebra slips slightly forward on the one below it, a condition called degenerative spondylolisthesis. In advanced cases, the spine may even develop a sideways curve (degenerative scoliosis).
Common Symptoms
Pain and stiffness are the hallmarks. Because the damage is mechanical, symptoms are typically worse when you bend or twist your spine and may ease when you sit or lean forward. Many people notice a grinding sensation when moving their back or neck. The lower back is the most common location, but cervical (neck) arthrosis is also widespread and can trigger headaches.
Symptoms vary widely from person to person. Some people with significant arthrosis on imaging have no pain at all, while others experience:
- Localized back or neck pain that worsens with activity
- Morning stiffness that loosens up after moving around
- Loss of flexibility in the spine, such as difficulty straightening up or turning your head
- Pain, numbness, or tingling in the arms or legs if bony spurs or swollen tissue compress a nerve
- Leg cramping or weakness while walking (neurogenic claudication), which is a sign of spinal canal narrowing
Nerve-related symptoms deserve particular attention. When arthrosis narrows the spaces where nerves exit the spine, standing and walking can bring on pain, tingling, or cramping in the legs that improves when you sit down or lean over a shopping cart.
Who Gets It and Why
Age is the strongest predictor. Nearly everyone over 60 shows at least some facet joint changes on imaging, though not everyone develops symptoms. Beyond aging, several factors raise your risk or speed up the process.
Carrying extra weight places ongoing mechanical stress on the spine. A BMI of 30 or above is consistently linked to higher rates of disc degeneration and facet joint disease. Research on a genetic variant associated with fat metabolism (the FTO gene) suggests that obesity and spinal degeneration may share overlapping biological pathways, meaning some people are genetically predisposed to both.
Previous spinal injuries, repetitive heavy lifting, and jobs that involve prolonged vibration (like truck driving) accelerate wear. Spinal alignment also matters: people with scoliosis or abnormal curvature place uneven loads on their facet joints year after year.
How It’s Diagnosed
Diagnosis starts with your symptoms and a physical exam, but imaging confirms it. Standard X-rays can reveal the classic signs: narrowing of the joint space, bone spur formation, and thickening of the bone beneath the cartilage. Doctors often use a grading system originally developed by Kellgren and Lawrence that scores severity from 0 (normal) to 4 (severe), where grade 2 means definite bone spurs with possible joint space narrowing and grade 4 means large spurs, marked narrowing, and visible changes to the bone shape.
MRI adds another layer of detail. It can detect active inflammation in the joint lining and swelling in the surrounding bone, which correlate more closely with pain than bone spurs alone. MRI is also essential for spotting nerve compression, disc problems, and other conditions that often coexist with facet joint arthrosis.
Non-Surgical Treatment
Most people with spinal arthrosis never need surgery. The first line of management combines movement, pain control, and lifestyle changes.
Physical therapy is the cornerstone. Strengthening the muscles that support the spine, particularly the deep core and back extensors, takes mechanical load off the facet joints. Stretching and flexibility work help maintain range of motion. Low-impact exercise like swimming, walking, and cycling keeps joints mobile without jarring them.
When oral pain relievers aren’t enough, facet joint injections are one of the most commonly performed spinal procedures. A combination of local anesthetic and a steroid is injected directly into the joint, providing immediate and then longer-lasting relief by calming inflammation. If injections provide temporary relief but the pain returns, radiofrequency ablation is an option: the small nerve branches that carry pain signals from the facet joint are heated to interrupt those signals. A recent 10-year study of cryotherapy (using cold instead of heat to disrupt the same nerves) found that patients’ pain scores dropped from 9 out of 10 before treatment to 2 out of 10 afterward, and over half reduced their pain medication use.
Diet and Inflammation
Because chronic low-grade inflammation drives both pain and ongoing joint damage, what you eat matters more than most people realize. A Mediterranean-style diet, rich in fatty fish, colorful vegetables, whole grains, and olive oil, provides three key anti-inflammatory components: omega-3 fatty acids (from fish like salmon, sardines, and mackerel), polyphenols (from plant foods and olive oil), and vitamin C (a powerful antioxidant that helps counteract cellular damage). Maintaining healthy gut bacteria through probiotic and prebiotic-rich foods also appears to help keep systemic inflammation in check. No single food will reverse arthrosis, but a consistently anti-inflammatory eating pattern can meaningfully reduce symptom burden over time.
When Surgery Becomes Necessary
Surgery is reserved for people whose symptoms don’t respond to at least 12 weeks of conservative treatment, including physical therapy and injections. The most common scenario is spinal stenosis, where arthrosis has narrowed the canal enough to compress the spinal cord or nerve roots, causing progressive weakness, persistent leg pain, or difficulty walking.
The standard procedure is a laminectomy: removing a portion of bone to create more space for the nerves. If the spine has become unstable, meaning one vertebra is slipping on another or there’s a significant curve, a fusion is added to lock the affected segments together and prevent further movement. Fusion is specifically indicated when arthrosis has led to spondylolisthesis, scoliosis, or kyphosis, because decompression alone could worsen instability in those cases.
A rare but urgent situation called cauda equina syndrome, where the bundle of nerves at the base of the spine is severely compressed, requires emergency surgery. Warning signs include sudden loss of bladder or bowel control, numbness in the groin area, and rapidly worsening leg weakness.