What Is Facet Joint Syndrome?
Each vertebra connects to its neighbours by the disc and vertebral body in front and by two small joints (the facet joints) at the back. These small joints control the spine's bending and twisting movements and limit excessive motion. Just like the knee or hip, the facet joints can wear over time; the cartilage thins, the joint capsule becomes irritated and bony spurs may develop around them. The pain arising from this degenerative process is called facet joint syndrome. It is most often seen in the lower back (lumbar facets) but can also occur in the neck (cervical facets). The key concept is this: facet joint syndrome is a 'joint-wear' condition; in most patients it is not an emergency that directly compresses the spinal nerves, but rather a source of chronic mechanical pain that affects quality of life.
Symptoms: Clues That Suggest Facet Pain
The most typical symptom of facet joint syndrome is a deep, dull pain felt in the lower back, often more pronounced on one side. This pain classically increases with bending backwards, prolonged standing, twisting the trunk and with the first movements in the morning; it may ease somewhat with bending forwards and sitting. The pain can sometimes spread to the buttock and the upper-back part of the thigh, but leg pain (sciatica) that runs down to the knee, reaches the toes and is accompanied by numbness or weakness — as in a disc herniation — is generally not expected. This distinction matters: facet pain is mostly a 'joint-related, mechanical' pain. Even so, symptoms alone do not make a definite diagnosis; similar complaints can come from the disc, the sacroiliac joint and other causes.
Diagnosis: Why MRI Alone Is Not Enough
The most common pitfall in diagnosing facet joint syndrome is assuming that facet wear seen on MRI is directly the source of the pain. Yet after a certain age most people's MRI shows facet degeneration, and not all of it causes pain. For this reason the diagnosis rests on interpreting the history and examination findings together with imaging. The most valuable method to clarify whether the pain truly arises from the facet is a diagnostic facet block: under imaging guidance, a local anaesthetic is delivered into the relevant joint or to the small nerve that supplies it (the medial branch); a marked, temporary reduction in pain strongly supports that joint as the source. This test both confirms the diagnosis and helps predict whether the subsequent treatment (especially radiofrequency) is likely to work.
Treatment: Radiofrequency and Injections Are Mainstays, Surgery Is Rare
Treatment of facet joint syndrome is stepwise and mostly non-surgical. The first step is a conservative approach: adjustment of pain-relieving/anti-inflammatory medication, weight control, posture education and, especially, physiotherapy-exercise programmes that strengthen the trunk muscles. When these are insufficient, interventional pain methods come onto the agenda. A facet joint injection (steroid + local anaesthetic into or around the joint) can reduce pain for a period. For a more durable result, in cases confirmed by a diagnostic block, radiofrequency thermocoagulation (RF) is a mainstay: the medial branch nerve carrying the joint's pain signal is suppressed with heat energy, and many patients can gain months of relief. Surgery (for example fusion) is rarely needed for facet syndrome itself; however, if there is an accompanying structural problem such as significant instability or advanced stenosis, this is assessed separately.
Realistic Expectations and an Honest Assessment
The honest picture in facet joint syndrome is this: in most patients it is a manageable but not completely 'erased' condition, because there is an underlying degenerative process. Radiofrequency and injections markedly reduce pain and improve quality of life in many patients; however, the duration of effect varies from person to person, and because the nerve regenerates over time RF may need to be repeated. No method is a 'guaranteed permanent solution'; the aim is to control the pain, preserve mobility and avoid unnecessary surgery. The same treatment is not applied to every patient — the approach is personalised according to the source of the pain, accompanying problems and the patient's response. Our priority is to provide the most benefit with the least intervention and to recommend surgery only when it is genuinely needed.