Facet Joint Syndrome (Lumbar)

Facet joint pain arises from:

• Age-related osteoarthritis — the most common cause; cartilage degeneration, bony spur formation, and joint capsule inflammation develop progressively with age
• Intervertebral disc degeneration — as discs lose height, more compressive and rotational load is transferred to the facet joints, accelerating their degeneration
• Spondylolisthesis — slipping of one vertebra on another stresses the facet joints at the affected level
• Post-surgical changes — following spinal decompression (particularly laminectomy), increased load on the facet joints can accelerate degeneration
• Obesity — increases compressive load on lumbar facet joints
• Repetitive extension loading — occupational or sporting activities involving repeated lumbar extension

The pain from lumbar facet joint syndrome has characteristic features that help distinguish it from discogenic or neurogenic pain:

Back Pain Characteristics

• Deep, aching pain localised to the lower back, typically worse on one or both sides of the midline
• Pain that is worse with lumbar extension (bending backwards) and rotation
• Morning stiffness that is typically worse on waking and eases with gentle movement
• Worsening pain after prolonged standing
• Pain that may radiate into the buttocks and upper thighs (referred pain), but does not typically extend below the knee

What Facet Joint Syndrome Does Not Cause

Unlike nerve root compression, pure facet joint syndrome does not typically cause pain radiating below the knee, numbness or tingling in the feet, or leg weakness. If these features are present, additional pathology — such as disc herniation or spinal stenosis — should be investigated.

Facet joint pain can be challenging to diagnose with imaging alone, as MRI and CT changes in the facet joints do not always correlate with symptoms. At One Brain and Spine, diagnosis is confirmed using a combination of:

Clinical Assessment

A detailed history and physical examination identify the characteristic pattern of facet-mediated pain — provocation by extension and rotation, point tenderness over the posterior facet joints, and pain referral patterns consistent with specific lumbar levels.

Imaging

• MRI — demonstrates facet joint arthritic changes, joint effusions, and coexisting disc pathology
• Bone scan (SPECT CT) — particularly useful for identifying which facet joints are metabolically active (inflamed) and therefore symptomatic. This allows highly targeted injection therapy at the correct levels.

Diagnostic Medial Branch Blocks

The gold-standard diagnostic test for facet joint pain is a medial branch block — a small injection of local anaesthetic around the nerves supplying the facet joints (medial branches of the dorsal rami). If the injection provides significant temporary pain relief (typically 50% or greater reduction), this confirms the facet joints as the pain source and guides further treatment.

Non-Surgical Treatment Options

Most patients with lumbar facet joint syndrome respond well to conservative management:

• Physiotherapy — core strengthening, postural correction, and exercises that offload the facet joints
• Clinical Pilates — particularly effective for developing lumbar stability
• Activity modification — reducing repetitive extension loading
• Analgesic and anti-inflammatory medications — for acute flare-ups
• Heat therapy — often provides effective relief for facet joint pain
• Weight management — reducing BMI decreases facet joint loading

Interventional Treatments

When conservative measures are insufficient, targeted interventional procedures offer effective relief:

• Lumbar facet joint injections — corticosteroid injected directly into the facet joint under imaging guidance; both diagnostic and therapeutic. Usually performed as a day procedure in Melbourne.
• Medial branch nerve blocks — local anaesthetic injection around the nerves supplying the facet joints; confirm the diagnosis and provide temporary relief
• Radiofrequency ablation (RFA) — a minimally invasive procedure using heat energy to interrupt the pain signal from the facet joint nerves. Provides sustained pain relief typically lasting 12–24 months. Well-established and widely used in Melbourne. Can be repeated when pain returns.

When is Surgery Required?

Surgery is rarely required for isolated facet joint syndrome. However, when facet joint arthritis is associated with significant spinal stenosis, spondylolisthesis, or instability causing leg symptoms or functional limitation, surgical decompression and fusion may be indicated. Your neurosurgeon at One Brain and Spine will assess whether surgery is appropriate in your individual case.