Facet joint osteoarthritis

What are facet joint osteoarthritis and facet pain?

Facet joint osteoarthritis means degenerative changes in the facet, or intervertebral, joints. These small paired joints lie behind the vertebral bodies and, together with the disc, contribute to movement of the segment. Changes in cartilage, joint surfaces and loading can be accompanied by pain.

However, the term “facet joint osteoarthritis” in an MRI or CT report does not by itself establish the cause of your symptoms. The facet joints, disc, neural structures and other tissues can cause different or combined symptoms. The aim of the consultation is to identify exactly what treatment should target.^[1]

Which symptoms need assessment?

Joint-related pain may cause stiffness and localized low back pain, particularly with extension, rotation or prolonged standing. Pain may also be felt in the buttock or thigh. These features help guide assessment, but do not confirm a facet origin of pain on their own.^[1]

If pain spreads into the leg, or there is numbness, weakness or a reduced walking distance, we separately check whether nerves are being compressed. Degenerative joint changes may coexist with spinal canal stenosis.^[4]

How we identify the source of pain

We begin with your symptoms and previous treatment: where it hurts, which movements provoke pain, what provides relief and how pain affects work and sleep. During examination, we assess movement, strength, sensation and reflexes.

• Existing images: send MRI/CT studies or X-rays if they have already been performed.
• Previous procedures: state which injections or other procedures you had, what effect they had and how long it lasted.
• Medicines and medical conditions: prepare a list of medicines and information on allergies and coexisting conditions.

Additional investigations are ordered according to clinical need. The severity of arthritis on an image alone is insufficient to select denervation.^[1] You do not need to arrange a new MRI or CT yourself for preliminary review.

If you have digital investigations, send the complete series in DICOM format. How to prepare and send MRI/CT studies to the professor.

A diagnostic block before choosing a procedure

If we suspect a facet source of pain and are considering radiofrequency treatment, we may discuss a medial branch block: an injection targeting the small nerve branches that transmit signals from the joints. A local anaesthetic temporarily affects pain transmission; the procedure is image-guided.

After the block, it is important to assess your usual pain and the movements that caused it. The result helps select patients, but does not guarantee the effect of a subsequent procedure.^[1] Before the procedure, you will receive an explanation of what to record and when to report changes.

Radiofrequency neuroablation for facet joint osteoarthritis

Radiofrequency neuroablation, or denervation, targets the nerve branches transmitting pain from the facet joints. Electrodes are passed through special needles to deliver targeted thermal treatment. The aim is to reduce joint pain transmission and make activity easier.

This procedure does not restore joint cartilage or relieve nerve compression in the spinal canal. We discuss the reasons for choosing it, its possible effect, risks and alternatives before treatment.

What we consider when choosing treatment

International recommendations differ. NICE allows consideration of denervation after non-surgical treatment has provided insufficient relief and a diagnostic block has been positive. The 2025 BMJ guideline recommends against facet radiofrequency ablation for chronic axial spinal pain.^{[2], [3]} The decision therefore requires an individual discussion of expected benefit and the limitations of the evidence.

When endoscopic surgery is needed

My specialty is endoscopic spine surgery. If joint enlargement and other degenerative changes narrow the space for nerves, we assess indications for endoscopic decompression. Its purpose is to release neural structures in stenosis that corresponds to the symptoms and examination findings.

The camera provides a magnified view, while instruments work through small approaches. We determine the extent of surgery according to the sites of compression and the supporting structures that need to be preserved. More about endoscopic treatment of lumbar stenosis.

If symptomatic instability or other indications are present, we discuss stabilization separately. Joint osteoarthritis alone does not mean that screws or a cage are required.^[5] Decompression and stabilization for slipped vertebrae.

What non-interventional treatment includes

The plan may include selected exercises, gradually increasing activity, adapting your workstation and pain treatment that takes coexisting conditions into account. It is important to assess changes in function and everyday activity and adjust loading accordingly.

At consultation, we will determine what has already been tried, whether this approach is sufficient and what next step makes sense in your situation.^[2]

From the first enquiry to a treatment plan

1. Send a description of your pain and your investigations. Include existing images and the results of previous treatment. Preliminary review is free.
2. Attend a consultation and examination. We clarify the possible source of pain and the need for additional diagnostics.
3. Agree on the next step. Rehabilitation, a diagnostic block, discussion of denervation, or surgery when nerve compression is present.
4. Obtain a preparation plan. If a procedure is chosen, we clarify medicines, investigations, pain relief and arrangements for going home.
5. Assess the result over time. We monitor pain, mobility and return to usual activities.

Activity and recovery after treatment

Advice depends on the selected method. After a diagnostic block, it is important to record changes in your usual pain. After denervation, we agree on a gradual return to activity and when to assess the result.

After endoscopic decompression, you receive a separate plan for walking, everyday movements, work and driving. If stabilization was performed, we also take the development of fusion into account. Timing is discussed according to your procedure and type of work.

Questions about facet joint osteoarthritis

Can the cause of pain be determined from MRI alone?

No. Images show anatomical changes; decisions also consider examination findings, the nature of pain and the results of previous treatment.

How does denervation differ from endoscopic decompression?

Denervation affects the nerve branches transmitting joint pain. Decompression releases neural structures from compression. These are different aims with different indications.

Are screws always necessary for joint osteoarthritis?

No. The need for stabilization is assessed separately. Segmental instability, deformity and the planned extent of decompression are important.

What result can I expect after a radiofrequency procedure?

The aim is to reduce pain and improve activity. The extent and duration of the effect vary; we discuss whether the procedure is appropriate and the reasons for choosing it in view of the mixed evidence.

What should I send for preliminary review?

A brief description of pain, its duration, the results of previous treatment and existing investigations. Send complete MRI/CT studies in DICOM format; after surgery, include a discharge summary.

How can I find out the cost of treatment?

First, we clarify the source of symptoms and the method needed. We then discuss the plan, treatment facility and cost.