Lumbar Osteoarthritis and Facet Syndrome Treatment

Facet syndrome is a chronic condition caused by degenerative wear of the facet joints connecting the vertebrae at the back of the spine. It features morning stiffness, lower back pain that increases when leaning backwards, and pain radiating to the buttock. Exercise and physiotherapy are first-line treatments; radiofrequency treatment (facet joint denervation) is used when the joints are confirmed as the source of pain.

What Is Facet Syndrome?

Facet joints are small joints connecting the 5 lumbar vertebrae at the back of the spine, helping it move flexibly forwards, backwards and sideways. Wear developing in these joints over time is called facet joint osteoarthritis [1]. Degeneration becomes very common with age, reaching 89% in the 60–69 age group; however, no association was found between osteoarthritis seen on imaging and lower back pain [2]. In other words, an imaging finding of osteoarthritis alone does not show that the joint is the pain source. Facet syndrome, where the degeneration actually causes clinical pain, is established separately through examination findings and further assessment.

What Causes Facet Syndrome, and What Are Its Symptoms?

Age-related wear, repeated mechanical loading, excess weight and previous lower back injuries all contribute. The condition may therefore also occur in younger people who do heavy physical work or carry loads without proper control. Clinically, it presents with:

• Morning Stiffness: Intense stiffness, a feeling of being “rusty” and difficulty moving the lower back at the start of the day.
• Pain When Leaning Backwards: Increased severe pain from joint compression when extending the trunk backwards.
• Referred Pain: Pain spreading to the buttock and back of the thigh, but usually not below the knee or to the toes.
• A Cycle of Inactivity: Pain reduces movement, which weakens muscles and worsens symptoms.

How Is Facet Syndrome Diagnosed?

Diagnosis combines a physician’s examination, assessment of pain characteristics and imaging. The examination looks for tenderness and pain over the facet joints during backward bending (extension) or rotation. Standing lumbar X-rays show joint-space narrowing and bony outgrowths (osteophytes). Lumbar MRI is requested to assess associated problems such as disc degeneration and thickening of the ligament within the spinal canal (ligamentum flavum). In uncertain cases, substantial pain relief after an imaging-guided diagnostic facet block (temporary numbing test) supports the joint as the pain source and guides treatment.

Treatment of Lumbar Osteoarthritis and Facet Syndrome

In our clinic, we take a comprehensive, scientific approach to freeing patients from this cycle:

• First Stage (Pain Relief): International guidelines recommend a stepwise approach: exercise and physiotherapy first; if pain appears facet-related, a diagnostic facet block is performed, and facet joint denervation (radiofrequency treatment) is considered as an interventional pain procedure in patients responding well [4]. Radiofrequency reduces pain for up to 12 months in suitable patients [3].
• Second Stage (Education and Protection): This is at least as important as the first. Once pain has eased, patients receive a personalised exercise programme to prevent further joint wear and learn which daily behaviours support healthy spinal structure and which to avoid.

🩺 Physician’s Insight & Clinical Experience

“The most common misconception I encounter in patients with lumbar osteoarthritis is treating the degeneration seen on imaging as the sole explanation for their pain and accepting it as an inevitable part of ageing. What really matters is establishing with a diagnostic block whether the pain actually comes from the facet joint. Radiofrequency denervation can provide meaningful relief in patients selected accordingly. Developing a regular exercise habit is at least as important as interventional treatment; strong back and abdominal muscles help reduce the load on the facet joints.”

Frequently Asked Questions

What Happens If Lumbar Osteoarthritis Is Not Treated?

Degeneration progresses over time and bony spurs (osteophytes) develop, contributing to canal narrowing in some patients. Reduced movement due to pain also weakens the lower back muscles, creating a cycle of worsening symptoms.

Can Lumbar Osteoarthritis Be Treated Without Surgery?

Yes, non-surgical methods are the first choice: treatment starts with physiotherapy and exercise. If the pain appears facet-related, a diagnostic facet block is performed, followed by radiofrequency denervation in patients with a good response.

Are Morning Lower Back Stiffness and Pain Signs of Osteoarthritis?

Yes, morning stiffness is the most typical feature of facet syndrome: a “rusty” feeling on waking that eases with movement within 15–20 minutes. However, this alone does not establish the diagnosis; similar symptoms occur in other spinal conditions.

When Does Lumbar Osteoarthritis (Facet Disease) Require Surgery?

Surgery is considered when degenerative changes compress nerves and cause weakness or marked limitation of walking distance (spinal stenosis), or when accompanying spondylolisthesis and symptoms progress despite non-surgical treatment. Decompression without screws or stabilisation with screws is then assessed.

Can Lumbar Osteoarthritis Cause Pain Radiating to the Legs?

Yes, but it differs from disc-herniation pain. Facet-related “referred pain” spreads to the buttock and back of the thigh, rarely extends below the knee and does not follow a specific nerve pathway. Pain extending below the knee to the calf and toes with numbness suggests an accompanying lumbar disc herniation.

Which Specialist Treats Lumbar Osteoarthritis in Istanbul?

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

How Much Does Treatment Cost?

As treatment costs vary according to the patient and hospital conditions, a definite fee can only be determined after examination and review of imaging.

References

1. Gellhorn AC, Katz JN, Suri P. Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol. 2013;9(4):216-224. PMID: 23147891.
2. Kalichman L, Li L, Kim DH, et al. Facet joint osteoarthritis and low back pain in the community-based population. Spine (Phila Pa 1976). 2008;33(23):2560-2565. PMID: 18923337.
3. Lee CH, Chung CK, Kim CH. The efficacy of conventional radiofrequency denervation in patients with chronic low back pain originating from the facet joints: a meta-analysis of randomized controlled trials. Spine J. 2017;17(11):1770-1780. PMID: 28576500.
4. Cohen SP, Bhaskar A, Bhatia A, et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Reg Anesth Pain Med. 2020;45(6):424-467. PMID: 32245841.

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