What Is Bilateral Facet Arthrosis and How Is It Treated?

Bilateral facet arthrosis means arthritis in the small joints that link the vertebrae, on both the left and right sides of the spine. It is one of the most common reasons for long-lasting low back pain, and most people manage it without surgery.1Spine Connection. Facet Arthropathy Causes, Symptoms & Treatments Seeing it on a scan doesn’t by itself prove it is the source of your pain, which is why treatment often begins with confirming that.

What the Facet Joints Do and What Wears Down

Each vertebra has a pair of facet joints at the back, one on each side. They are lined with smooth cartilage and sealed in a fluid-filled capsule.2PubMed Central. Spinal Facet Joint Biomechanics and Mechanotransduction in Normal, Injury and Degenerative Conditions Together with the disc in front, they carry load and guide and limit how the spine bends and twists.3PubMed Central. Spinal Facet Joint Biomechanics and Mechanotransduction in Normal, Injury and Degenerative Conditions Because the two sides work as a pair, wear usually shows up on both, and that is all “bilateral” on a report means.

The first changes are small rough patches and pits on the cartilage surface, along with inflammation and thickening of the joint capsule.4PubMed Central. Osteoarthritis of the spine: the facet joints Over years the cracks deepen and the cartilage erodes, so the gap between the joint surfaces narrows.5PubMed Central. Osteoarthritis of the spine: the facet joints Later the bone under the cartilage reacts, and bony spurs form at the joint edges.6PubMed Central. Osteoarthritis of the spine: the facet joints7PubMed. Histological Osteoarthritic Changes in the Human Cervical Spine Facet Joints Related to Age and Sex These changes become more common with age, and men tend to show more extensive cartilage wear.8PubMed. Histological Osteoarthritic Changes in the Human Cervical Spine Facet Joints Related to Age and Sex

Imaging reports use several terms for this. Arthrosis, arthropathy and osteoarthritis of the facets usually describe the same wear process. “Joint space narrowing” means the cartilage has thinned. “Hypertrophy” means the joint or capsule has enlarged with wear, and “osteophytes” are the bone spurs.

Facet wear is a normal part of spinal aging, and many people with these changes on their scans have little or no pain. The report describes structure, while your symptoms decide treatment.

Wear is also often uneven. One side can look worse than the other even when the report says bilateral. Pain may come mostly from one side, and the worse-looking joint isn’t necessarily the one that hurts. The grade (mild, moderate or severe) describes how the joint looks, not how much pain to expect.

Why the Lower Back Is Hit Hardest

A healthy disc takes much of the compression when you stand, while the facets mainly guide motion and take a smaller share. When a disc bulges or loses height, the space between vertebrae narrows and more pressure shifts onto the facet joints.9Spine Surgery. Spine Surgery | Spine Treatment Beverly Hills CA That speeds up cartilage wear, and the joint may slide slightly out of its normal alignment, adding more strain. So disc degeneration and facet arthritis often appear together on the same scan.10Spine Surgery. Spine Surgery | Spine Treatment Beverly Hills CA Facet wear can also follow disc surgery when a lot of disc material is removed or the disc space narrows.11PubMed. Protecting facet joints post-lumbar discectomy: Barricaid annular closure device reduces risk of facet degeneration

Location matters too. In adults without nerve narrowing, facet arthrosis was found at about 16% of the L3-L4 level, 28% at L4-L5 and 55% at L5-S1, the lowest joint.12PubMed. Facet joints arthrosis in normal and stenotic lumbar spines Those labels name the vertebrae above and below the joint. L5-S1 is where the lower back meets the pelvis, and the lowest levels bear the most body weight and movement.

Weight plays a part as well. On lumbar CT, overweight people had almost three times and obese people about five times the risk of facet arthritis compared with normal weight.13PubMed Central. Osteoarthritis of the spine: the facet joints In the neck the link with weight is very small.14PubMed Central. Osteoarthritis of the spine: the facet joints Age and past disc wear can’t be reversed, but body weight is within your control, and losing weight reduces the load each joint carries with every step.

What Facet Arthrosis Pain Feels Like

Flares tend to come from standing at a counter, reaching to a high shelf, or arching back to look up, and the ache often settles within minutes of changing position. Getting out of a chair or turning over in bed can bring a catch of pain that eases once you get moving.

This pattern isn’t proof. Facet pain can mimic a herniated disc or a pinched nerve root, so history and examination can suggest the facets but cannot confirm them as the pain source.21PubMed Central. Facet joint syndrome: from diagnosis to interventional management

Sciatica is different. It usually shoots down the leg below the knee and may bring numbness, tingling or weakness in the leg or foot. Facet pain stays mostly in the back and buttock as an ache.

Some symptoms need prompt attention: new leg weakness or foot drop, or back pain with fever, weight loss or a history of cancer. Numbness in the groin or loss of bladder or bowel control needs emergency care.

Exercise and Everyday Treatment Come First

People with facet arthrosis low back pain who followed an exercise program had less pain and disability than those who did not.22PubMed. The effectiveness of telerehabilitation-based exercise combined with pain neuroscience education for patients with facet joint arthrosis: A randomized controlled study Learning how pain works alongside the exercise also helped change fearful beliefs about damage.23PubMed. The effectiveness of telerehabilitation-based exercise combined with pain neuroscience education for patients with facet joint arthrosis: A randomized controlled study Programs done by video at home with a therapist’s guidance were effective too.24PubMed. The effectiveness of telerehabilitation-based exercise combined with pain neuroscience education for patients with facet joint arthrosis: A randomized controlled study Swimming and water exercise are often well tolerated because they unload the joints.25MIN Clinic — Minimally Invasive Neurosurgery Clinic. Spondyloarthrosis (Facet Joint Osteoarthritis): Symptoms, Diagnosis & Treatment

A good program includes core and hip strengthening to share load away from the joints, and gentle forward-bending stretches, which suit facet pain. General fitness, such as walking in comfortable bouts, belongs in it as well. Results aren’t instant, so progress steadily over weeks.

To start when your back hurts, begin with short, gentle sessions that leave you no worse the next day, then add time or repetitions gradually. A physical therapist can set up a program matched to your pain pattern and check your technique, and many people need only a few visits before continuing at home. Pick movements you can keep up regularly, since steady practice matters more than intensity.

Rest is a common trap. Arthritic joints stiffen further with prolonged rest, and some discomfort during exercise does not mean harm. Staying active is part of treatment, not a risk.

A few habits ease the joints day to day. Break up long standing with short sits, and avoid long stretches of leaning back, as in overhead work. Heat in the morning can ease stiffness. Over-the-counter anti-inflammatories can help short-term if they are safe for you, so check with a pharmacist.

Test Injections That Confirm the Source

A medial branch block injects local anesthetic near the tiny nerves that carry pain from the facet joints. If your usual pain drops sharply for the hours the numbing lasts, the facets are likely the source. But single blocks give a false positive in about 25% to 44% of people.26Pain Physician. A Best-Evidence Systematic Appraisal of the Diagnostic Accuracy and Utility of Facet (Zygapophysial) Joint Injections in Chronic Spinal Pain So many specialists repeat the block on a second day before going further.

How much relief counts matters. Using at least 80% relief as the bar picks out people whose facet diagnosis held up 2 years later about 90% of the time.27Pain Physician. Making Sense of the Accuracy of Diagnostic Lumbar Facet Joint Nerve Blocks: An Assessment of the Implications of 50% Relief, 80% Relief, Single Block, or Controlled Diagnostic Blocks With a looser 50% bar, the diagnosis held for only about half after 2 years.28Pain Physician. Making Sense of the Accuracy of Diagnostic Lumbar Facet Joint Nerve Blocks: An Assessment of the Implications of 50% Relief, 80% Relief, Single Block, or Controlled Diagnostic Blocks Among people with long-lasting back pain, the facets are the true source in roughly 16% to 41%.29Pain Physician. A Best-Evidence Systematic Appraisal of the Diagnostic Accuracy and Utility of Facet (Zygapophysial) Joint Injections in Chronic Spinal Pain

Treatments aimed at the facet nerves only help if those nerves carry your pain. Confirming first matters most when exercise and simple measures have not been enough and a nerve-heating procedure is being considered.

The appointment is done as an outpatient with X-ray guidance, usually in under an hour. You lie face down and feel pressure and brief stinging. Afterward you’re asked to do things that normally hurt and to keep a pain diary for the next hours. Arrange a ride home.

A negative result is still useful. It points the search toward discs, nerves or other causes.

Radiofrequency Ablation for Lasting Relief

Radiofrequency ablation (RFA) uses a heated needle tip to disable the small nerves that carry facet pain. In people who passed two test blocks with at least 80% relief, about 63% to 66% had their pain at least halved from 6 months to 2 years.30PubMed. The Effectiveness of Radiofrequency Ablation of Medial Branch Nerves for Chronic Lumbar Facet Joint Syndrome in Patients Selected by Guideline-Concordant Dual Comparative Medial Branch Blocks After 2 years that share fell to about 44%.31PubMed. The Effectiveness of Radiofrequency Ablation of Medial Branch Nerves for Chronic Lumbar Facet Joint Syndrome in Patients Selected by Guideline-Concordant Dual Comparative Medial Branch Blocks The nerves slowly regrow, so pain can return.

Using X-ray guidance, the doctor places a thin needle beside the small nerves identified by the test block, after numbing the skin. A radiofrequency current heats the tip for a short time, which disables the nerve’s ability to carry pain signals. Several joints are often treated in one session, usually the ones that responded to the test blocks, and most people go home the same day.

Soreness or a sunburn-like feeling can last one to two weeks, and full benefit often takes a few weeks to show. If the nerves regrow and the procedure helped before, it can be repeated. RFA treats pain but does not repair the joint, so continuing exercise helps make the relief last.

Steroid and Platelet-Rich Plasma Joint Injections

Steroid injected into the facet joint calms inflammation and often helps within a day.32Journal of Orthopaedics, Trauma and Rehabilitation. Comparison of intra-articular lumbar facet joint injection of platelet-rich plasma and steroid in the treatment of chronic low back pain: A prospective study In one study the relief faded by 3 to 6 months, while platelet-rich plasma (PRP), made from your own blood, kept working.33Journal of Orthopaedics, Trauma and Rehabilitation. Comparison of intra-articular lumbar facet joint injection of platelet-rich plasma and steroid in the treatment of chronic low back pain: A prospective study Pooled trials found PRP reduced pain more than steroid at 3 and 6 months.34PubMed. Platelet-rich plasma versus corticosteroid injections for facet and sacroiliac joint pain: a systematic review and meta-analysis with trial sequential analysis These are small studies, though, and PRP is often not covered by insurance. Joint injections may be tried when RFA isn’t an option.

The doctor uses X-ray guidance to place a needle directly into the facet joint or around it, after numbing the skin. The medicine is delivered in a small amount, and the visit is usually brief with a short period of observation afterward. You may feel soreness at the site for a day or two, and steroid effects can take a few days to appear fully.

Steroid shots have limits. Doctors cap how many you get per year, and people with diabetes may see blood sugar rise for a few days.

When Surgery Is Considered

There is no convincing evidence that surgery helps pain from worn facet joints by itself, so non-surgical treatment should be tried first in most cases.35PubMed Central. Facet joint syndrome: from diagnosis to interventional management Complications change the picture. Enlarged facets, bone spurs and joint cysts can narrow the space around nerves, which doctors call spinal stenosis.36Spartan Medical Research Journal. Neuroforaminal Stenosis in the Lumbosacral Spine: A Scoping Review of Pathophysiology, Clinical Manifestations, Diagnostic Imaging, and Treatment Worn facets can also let one vertebra slip forward over the one below, called spondylolisthesis.37PubMed. Evolution of lumbar degenerative spondylolisthesis with key radiographic features For stenosis, decompression surgery that frees the nerves did better than non-surgical care in a trial.38PubMed Central. The Diagnosis and Treatment of Degenerative Changes of the Lumbar Spine For mild slips with stenosis, a newer facet replacement gave better results at 2 years than fusion, about 74% versus 26% success.39PubMed Central. Lumbar Facet Arthroplasty Versus Fusion for Grade-I Degenerative Spondylolisthesis with Stenosis

Signs your problem has gone beyond the joints include leg pain or heaviness when walking that eases when you sit or bend forward, and numbness or weakness in the legs. These point to narrowing around the nerves and warrant a spine surgeon’s opinion.

Surgeons first ask whether your symptoms come from the joint itself or from squeezed nerves, because the operations differ. An MRI shows whether the space around the nerves is narrowed, but they weigh it against your symptoms and exam, since scans alone can mislead. Leg symptoms that match the narrowed level strengthen the case for an operation, while back pain alone does not.

Useful questions for a surgeon: what exactly the operation fixes, and whether that is nerves or joint pain; the success rate for your specific problem; and the recovery time and which non-surgical options remain.

Stem Cells and Other Experimental Treatments

In a small early trial of donor stem cells injected into the joint, 5 of 9 people showed less joint wear on MRI after 2 years.40PubMed Central. Intra-articular delivery of allogeneic bone marrow derived mesenchymal stromal cells (BM-MSCs) for painful lumbar facet arthropathy: a phase I clinical trial That trial was mainly about safety and too small to prove benefit. Other cell-based treatments have been tested only in animals so far.41PubMed Central. Hypoxia-treated adipose mesenchymal stem cell-derived exosomes attenuate lumbar facet joint osteoarthritis

Be wary of clinics charging cash for unproven stem cell shots. Legitimate options are usually offered through registered clinical trials, and it’s worth asking your specialist before paying anything.