Home / Conditions / Facet joint syndrome
Pain from the small joints at the back of the spine, worse when you lean backwards or twist, and easier leaning forward. It is one of the common causes of long-standing back and neck pain, and it behaves differently enough from a disc problem that the pattern usually gives it away.
These three cause most long-standing lower back pain, and what makes the pain worse usually separates them.
| Facet joint syndrome | A disc | Sacroiliac joint | |
|---|---|---|---|
| Worse when | Leaning backwards, twisting, standing a long time | Bending forwards, sitting, coughing | Standing on one leg, climbing stairs, turning in bed |
| Easier when | Leaning forwards, sitting | Standing, walking, lying down | Lying down |
| Where it is felt | Over the spine itself, spreading to the buttock or thigh, rarely past the knee | Often more in the leg than the back, past the knee | One-sided, low, over the buttock |
| More on it | This page | Slipped disc | Sacroiliac joint dysfunction |
Some back pain needs seeing today: numbness around the groin, buttocks or inner thighs, difficulty passing urine, or loss of bladder or bowel control; weakness in both legs, or weakness in one leg worsening by the hour. These are rare and are not caused by facet joints. See back pain for the full list.
Each pair of vertebrae meets at three points: the disc at the front, and two small joints at the back, one on each side. Those two are the facet joints. They work as hinges, guiding how far the spine bends and twists, and they carry more load as you lean backwards.
What a picture cannot show is why they hurt. Like any other joint, they have cartilage and a lining, and they wear. Worn joints become painful and stiff, and the wear also enlarges them, which is one of the ways the spaces the nerves pass through become narrowed — see spinal stenosis.
It also explains the treatment. Each facet joint gets its sensation from a small nerve branch, and that branch supplies nothing else — which is why numbing it can confirm the joint is the source, and why treating it can settle the pain without affecting movement or strength.
Pain that shoots past the knee, with numbness or pins and needles, points to a nerve instead — see sciatica.
Most people improve without surgery. Treatment is stepped, and the earlier steps are enough for the majority.
Staying active, with exercise for the trunk and hips, and changing the positions that load the joints — long standing, repeated arching or twisting. Stiff joints hurt more, so rest beyond a few days works against you.
Medication has a place while you get moving again, and heat often helps the morning stiffness. Neither changes the joint; they make the exercise possible.
Local anaesthetic, often with a steroid, placed next to the nerve under CT guidance. It confirms the source and gives relief for days to weeks — long enough to make progress with exercise.
For pain that keeps returning after blocks have shown which joint is responsible. Heat is applied to that small nerve branch until it stops conducting. Relief often lasts several months to a year or more; the branch regrows over time, and the treatment can be repeated. See neuromodulation.
Surgery is rarely part of facet joint syndrome treatment. It comes into the picture only when the facet wear sits alongside something else that needs it, such as spinal stenosis or spondylolisthesis.
Facet joint syndrome here is seen by Dr Mathew Tung, a neurosurgeon whose practice includes facet joint injections and denervation, and who works with radiologists to offer CT-guided facet blocks; and Dr Lim Heng Hing, a Senior Consultant Orthopaedic and Spine Surgeon, whose interventional work includes radiofrequency ablation for chronic back and neck pain.
The usual clue is what makes it worse. Facet pain is worse leaning backwards and easier leaning forwards; disc pain tends to be the opposite, and more often travels past the knee. A block settles it when the pattern is unclear.
Not by itself. Worn facet joints are common in people with no pain at all, particularly with age. The diagnosis rests on the pattern of symptoms, the examination, and the response to a block.
Days to weeks. Its main value is confirming the source and giving a window in which exercise becomes possible. Longer relief comes from treating the nerve branch itself.
It disables a small sensory branch that supplies only the joint, so movement and strength are unaffected. The branch regrows over time, which is why the relief, while long, is not permanent.
Very unlikely for facet joint syndrome alone. Surgery is considered when the wear sits alongside something else, such as spinal stenosis or a slipped vertebra.
No. Bring any X-ray, MRI or CT reports, and be ready to say which movements bring the pain on and which ease it.
Back pain · Lower back pain · Neck pain · Sacroiliac joint dysfunction · Spinal stenosis · Spondylolisthesis
Be ready to say which movements bring the pain on and which ease it. That pattern is what separates the facet joints from a disc.
