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Arthritis associated with the facet joints can occur anywhere along the spine. The pain associated with FJS is achy, dull, and throbbing, and can be made worse by activities that put pressure on the facet joints, such as extending the lower back, leaning backwards, and twisting at the waist. Some patients report back pain that radiates to the buttocks, thighs, and/or legs.

Many factors contribute to the cause of facet joint syndrome. The facet joints are often inflamed and irritated due to trauma, arthritic changes, and repetitive movements.

Degenerative changes of the facet joints from age and wear-and-tear lead to degenerative disc disease, where the intervertebral disc loses water content, frays, and wears down. When discs are damaged, the cushioning effect of the disc is lost. Therefore, the facet joints undergo stress, which results in degeneration.

There are several things that contribute to the development of facet joint syndrome. Risk factors include:

. Poor posture - With slumping, the facet joints break down under stress.
. Lack of proper body mechanics - Improper lifting, bending from the back, prolonged sitting, and poor rest positions all contribute to stress on the facet joints.
. Predisposing conditions - These include spondylolysis, spondylolisthesis, and degenerative disc disease.
. Advanced age - FJS is common in older adults.

The treatment of FJS depends on the severity of symptoms, the extent of the disease process, and previous methods tried. Treatment options include:

Medications - Back pain associated with FJS is treated with nonsteroidal anti-inflammatory drugs (NSAIDs), as well as antidepressants (amitriptyline) and muscle relaxants (Flexiril).

Physical therapy - To improve muscle strength, flexibility, and posture, the pain specialist may recommend a short course of physical therapy. The therapist uses several modalities to relieve the pain of spinal arthritis, such as ultrasound, heat, electrical stimulation, and massage.

Facet joint injections (FJI) - Also called a block, the doctor injects a long-acting anesthetic, with or without a corticosteroid, into the facet joints and near small nerves that are located there. Using x-ray guidance, the doctor inserts several small needles into the affected facet joints. The success rate of FJI was found to be 70%, according to a 2007 clinical study.

Laser or radiofrequency facet thermal ablation - When FJI relieves pain, the doctor may decide to perform facet thermal ablation. With this procedure, the doctor uses a laser or heated device to clean the joint and destroy the nerve root. One large review of clinical trials reported that these procedures offered long-term pain relief for low back pain of chronic nature.

Epidural steroid injection (ESI) - For chronic back pain, the doctor injects a corticosteroid into the epidural space, which is between the spinal cord and the epidural layer. Recent controlled studies show that ESI is effective for pain relief associated with spine disease.