Cervical Osteoarthritis and Its Treatment

Cervical osteoarthritis is the gradual wear of the discs and joints in the neck; the form involving the facet joints is medically known as facet syndrome. Typical symptoms are morning stiffness, neck pain that increases when tilting the head back or turning it, and restricted movement. Treatment has two components: first, pain is reduced; then exercises strengthen the neck muscles to relieve the load on the joints. Radiofrequency denervation (facet joint denervation) is used in patients whose pain originates in a facet joint. Surgery is considered only when neurological deficits develop because of nerve root or spinal cord compression.

What Is Facet Syndrome?

The neck contains 7 vertebrae that support the head. These vertebrae are connected at the back by special joints called facet joints, which allow the spine to move flexibly, in a controlled and healthy way. Over time, ageing, poor posture, carrying heavy loads or mechanical stresses such as physical work cause these joints to wear and degenerate. Medically called facet syndrome, this is the form of cervical osteoarthritis involving the facet joints and causes progressive neck pain. Facet osteoarthritis increases with age; advanced wear becomes more common after 60 and is a frequent cause of neck pain [1, 2]. As osteoarthritis progresses, bone spurs in the facet joints can narrow the nerve exit openings and the spinal canal; treatment is then planned according to the approach for spinal canal narrowing (cervical spinal stenosis).

Symptoms Caused by Osteoarthritis

Patients with cervical osteoarthritis generally experience the following symptoms:

• Morning Stiffness: Difficulty moving the neck and a feeling of stiffness after waking.
• Positional Pain: Local pain that becomes worse when tilting the head back or turning it towards the affected joint.
• Restricted Movement: Patients who avoid moving their neck to prevent pain gradually lose muscle strength, making everyday activities more difficult.

Diagnostic Methods for Cervical Osteoarthritis

Diagnosis combines physical examination and imaging. The examination assesses neck range of motion, pain and numbness spreading from the neck into the arm (radiculopathy), and reduced hand dexterity and unsteady walking suggesting spinal cord compression (myelopathy). X-rays show osteoarthritis in the facet and uncovertebral joints, loss of disc height and bone spurs. Cervical MRI clarifies the width of the spinal canal, narrowing of the nerve exit openings and compression-related changes in the spinal cord. Computed tomography (CT) is used when detailed assessment of bone structures and spurs is needed.

Treatment of Cervical Facet Syndrome

In our clinic, treatment for cervical osteoarthritis rests on two components:

Step 1 (Pain Relief)

Treatment begins with exercise and physiotherapy; during flare-ups, painkillers and muscle relaxants relieve pain but do not stop joint wear. If pain persists and the findings suggest that it comes from a facet joint, radiofrequency treatment (facet joint denervation) is considered as an interventional pain treatment; this method has been shown to reduce facet-related neck pain for months [3].

Step 2 (Patient Education and Rehabilitation)

Once pain has decreased, the patient receives a personalised exercise programme; strengthening the deep neck and back muscles reduces the load on the facet joints. Patients are also taught which everyday behaviours support a healthy spine and which to avoid.

🩺 Physician Insight & Clinical Experience

“The situation I encounter most often in cervical osteoarthritis is a patient who stops moving their neck altogether for fear of pain. In an inactive neck, the muscles weaken, and pain and restricted movement reinforce each other. That is why I first control the pain and then immediately get the patient moving; lasting results are achieved when the patient can follow the exercise programme after their pain decreases. I do not perform an intervention on every patient whose imaging shows osteoarthritis.”

Frequently Asked Questions

Are Morning Neck Stiffness and Pain Signs of Osteoarthritis?

Yes. Stiffness on waking that eases within 15–20 minutes of movement is typical of facet osteoarthritis. A joint that has remained still overnight is stiff in the morning and loosens with movement during the day. If stiffness lasts for hours and joints are swollen, inflammatory rheumatic disease also needs to be assessed.

Is Surgery Necessary for Cervical Osteoarthritis?

No, osteoarthritis itself does not require surgery. Surgery is considered when bone spurs compress a nerve root or the spinal cord, causing arm weakness, loss of hand dexterity or unsteady walking. Surgery is not the first choice for patients whose only symptom is pain.

Do Injections Offer a Permanent Solution for Cervical Osteoarthritis?

No, they are not a permanent solution. Radiofrequency denervation reduces pain by targeting the medial branch nerves that carry pain signals from the facet joint; it does not eliminate the joint’s osteoarthritis. As nerve fibres regenerate over time, pain may return and the procedure can be repeated. Regular exercise during this period helps maintain the relief achieved.

Does Facet Syndrome Cause a Cervical Disc Herniation?

No, it does not directly cause one. Facet joint osteoarthritis and disc wear are different parts of the same degenerative process and coexist in many patients.

Does Exercise Help Cervical Osteoarthritis?

Yes, exercise is a fundamental part of treatment. Clinical exercises that strengthen the deep neck and back muscles reduce the load on the facet joints. During periods of severe pain, exercise should be planned under medical supervision.

Can Cervical Osteoarthritis Cause Pain Radiating into the Arms?

Yes, facet-related pain can spread towards the shoulder and shoulder blade; this is called referred pain. If the pain reaches the forearm and fingers and is accompanied by numbness, tingling or weakness, nerve root compression (cervical radiculopathy) is suspected; a cervical disc herniation or spinal stenosis is then also investigated.

Is MRI or CT More Effective for Diagnosing Cervical Osteoarthritis (Facet Disease)?

Computed tomography (CT) shows facet joint osteoarthritis, wear of the joint surfaces and bone spurs (osteophytes) more clearly. MRI is needed to assess discs, nerve roots and the spinal cord. The examination findings determine which test is used.

Which Specialist Treats Cervical Osteoarthritis in Istanbul?

One of the physicians treating cervical osteoarthritis in Istanbul is Op. Dr. M. Levent Deniz, a specialist in brain, nerve and spine surgery.

How Much Does Cervical Osteoarthritis Treatment Cost?

Costs vary according to the patient and hospital conditions, so an exact price can only be determined after examination and assessment of imaging.

References

1. Park MS, Lee YB, Moon SH, et al. Facet joint degeneration of the cervical spine: a computed tomographic analysis of 320 patients. Spine (Phila Pa 1976). 2014;39(12):E713-E718. PMID: 24718073.
2. Gellhorn AC, Katz JN, Suri P. Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol. 2013;9(4):216-224. PMID: 23147891.
3. Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996;335(23):1721-1726. PMID: 8929263.

• 👨‍⚕️ Author and medical reviewer of this content: Op. Dr. M. Levent Deniz – Specialist in Brain, Nerve and Spine Surgery
• ⚠️ Medical Disclaimer: This page is for information only; consult your doctor for diagnosis and treatment.