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Lumbar Facet Arthritis

A common cause of low back pain in patients aged 40 and older. While younger patients typically experience pain due to disc-related issues, older populations often see degenerative changes in the facet joints.
  • Degenerative Origin
  • Age-Related Wear

DR JUSTIN PIK

Neurosurgeon and Spine Surgeon

DR MICHAEL OW-YANG

Neurosurgeon and Spine Surgeon

Patient History & Physical Exam

Identifying symptoms is the first step toward effective management.

Axial Low Back Pain

Deep, aching pain localized to the lower back region.

Pain with Loading

Discomfort is often worse when standing or walking for extended periods.

Reduced Range of Motion

Stiffness and difficulty during extension or lateral rotation.

Morning Stiffness

Pain that is most prominent upon waking but improves with movement.

Diagnostic Testing

CT SCAN

Excellent for viewing bony anatomy and osteophyte formation.

MRI IMAGING

Superior for soft tissue and viewing inflammation within the joint.
Key Radiological Findings:

Narrowing of joint space

Presence of Osteophytes (Bone Spurs)

Subchondral sclerosis and hypertrophy

Minimally Invasive Treatments

Steroid Injections

Level 1 Care
  • Performed by a radiologist; no specialist consultation required initially.
  • Effective primary step to escalate treatment if conservative measures fail.

Radiofrequency Denervations

High Success

60-70%

  • Success Rate for ~12 Months
  • The primary goal is pain alleviation to facilitate active rehabilitation & recovery.

Lumbar Fusion Surgery

Reserved for cases of severe or disabling pain that persists after all conservative and minimally invasive measures have been exhausted.

90%

Success Rate for Radiculopathy

Advanced surgical stabilization for degenerative changes.

Facet Synovial Cysts

Understanding secondary complications of facet joint arthritis.

Fluid-Filled Sacs

These cysts can develop as a result of arthritis, causing direct nerve compression and significant pain.

Observation

Needle aspiration is often attempted but frequently unsuccessful due to high recurrence rates.

Recommendation

Surgery might be required if symptoms persist or neurological deficits appear.

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