Conditions · Carrollwood · Tampa Bay
Spinal Arthritis & Facet Joint Pain
What facet arthropathy, spondylosis, and arthritis of the spine mean on your report, what they do and do not tell you, and how a doctor trained in spinal MRI interpretation connects the picture to the person.
A radiology report is written for other doctors, not for you. So when yours says facet arthropathy, facet hypertrophy, spondylosis, or degenerative joint disease, the words arrive without a translator. This page is the translator. Dr. Bobby Koser, DC, chiropractic physician, completed post-doctoral training in spinal MRI interpretation and clinical correlation, and reviewing the report with the person it belongs to is part of the examination here. Bring yours.
Spinal Arthritis and Facet Joint Pain Overview
What the words on your report mean
Every level of your spine has two small joints at the back, one on each side. They are the facet joints, and most of the arthritis vocabulary on a spine report is describing them, or describing them together with the disc in front.
Facet joints
Each pair sits at the back of a spinal segment, two vertebrae and the disc between them. They are lined with cartilage, the slick coating that lets bone surfaces glide, and wrapped in a capsule holding fluid. They steer how far that level bends, leans, and twists.
Also written as: zygapophyseal or zygapophysial joint (both spellings appear on reports), z-joint, apophyseal joint, vertebral joints, articular processes, or the posterior elements, the umbrella name for the structures at the back of a vertebra.
Facet arthropathy, facet arthrosis, facet joint osteoarthritis
Three ways of writing one picture: the cartilage lining a facet joint is thinned and the surfaces have changed shape. Arthropathy means joint condition; arthrosis and osteoarthritis both mean joint wear, and radiologists use them interchangeably. Your report may add where and how many: lumbar (low back), cervical (neck), thoracic (mid back), bilateral (both sides of one level), multilevel (more than one).
What none of those words carry is a date or a cause. When that appearance developed, and what it has to do with your pain, belong to your history and your examination.
Also written as: facet arthritis, facet joint OA, facet joint degeneration, facet degenerative changes, degenerative facet joints, facet disease. Disease in that last one is a naming habit rather than a second condition.
Facet hypertrophy, sclerosis, joint space narrowing, effusion
These four describe what a joint looks like rather than naming a condition. Hypertrophy means the bone around the joint is enlarged. Sclerosis, often written subchondral sclerosis, means the bone just under the joint surface reads as denser. Joint space narrowing means less gap between the surfaces. Effusion means extra fluid inside the joint capsule. Reports often mention these alongside the neural foramina, the openings where nerve roots pass out of the spine, because the facet joints sit beside them.
Spinal arthritis, degenerative joint disease, spondylosis
These are umbrella names for a region of the spine rather than one finding at one level, and they usually come down to the facet joints and the discs together. Spondylosis is the same picture written from the Greek word for vertebra: cervical spondylosis for the neck, lumbar for the low back. Degenerative joint disease, or DJD, is that picture in a third vocabulary. Multilevel counts levels; it does not measure pain.
Also written as: arthritis of the spine, arthritis in the back or neck, spinal osteoarthritis, osteoarthrosis, degenerative arthritis, spondylosis deformans, degenerative spondyloarthropathy, degenerative changes of the lumbar or cervical spine.
Osteophytes and bone spurs
An osteophyte, which reports also call a bone spur or spurring, is a small ridge of extra bone along the edge of a joint or a vertebra. Marginal osteophyte says where it sits, at the rim. In the neck you may also read uncovertebral, a second set of small ridged joints along the sides of the cervical vertebrae, where reports describe spurs too.
Facet syndrome and facet joint pain
These are clinical labels rather than imaging findings: they say a clinician believes pain is coming from a facet joint. A radiologist reports what a joint looks like. Whether that joint is the one producing your symptoms is a separate question, worked out by examination, and no single test, maneuver, or image settles it.
Also written as: facet joint syndrome, lumbar facet syndrome, thoracic facet syndrome, cervical facet syndrome, lumbosacral facet syndrome, facet mediated pain.
A finding is not a diagnosis
An image cannot tell anyone whether a particular person’s back hurts, and the research runs in two directions at once. In one study of 252 community-based adults with an average age of 67, CT scans of the low back, a form of X-ray imaging that shows bone in cross-section, found that what that study’s scale graded as severe facet joint osteoarthritis was more common in the people who reported back pain than in the people who did not: 63.2% compared with 46.7%. That association held after the researchers accounted for disc height narrowing along with background and health factors (odds ratio 2.15, 95% confidence interval 1.13 to 4.08, which is a comparison between two groups and its range of statistical uncertainty, not a number about any one person), and in that same study the odds of reporting back pain were higher for each additional joint graded that way (odds ratio 1.20 per joint).1 Read those same numbers the other way and 46.7% of the people who reported no back pain had those changes, and some of the people who did report back pain did not have them. In a separate review of 33 studies covering 3,110 people who reported no symptoms, degenerative changes showed up on spine imaging in high proportions, which is why those reviewers wrote that findings like these have to be read in the context of the patient’s clinical condition.2 Two things are true at the same time: a change on your scan is not automatically the source of your pain, and your pain is not less real because that change is a common one.
Those figures come from one group of older adults and describe low backs, so they do not carry over to a neck, to a younger spine, or to you. The first study reports an association and not a cause: it does not say a facet finding produced anyone’s pain. The report is the starting point. The examination connects it to you.
1. Suri P, et al. Presence and extent of severe facet joint osteoarthritis are associated with back pain in older adults. Osteoarthritis Cartilage. 2013;21(9):1199-1206. PubMed
2. Brinjikji W, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. PubMed
Arthritis is not one condition
When a spine report says arthritis, it is describing the facet joints and discs of one region. A different family of conditions carries the same word: rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and the wider group now called axial spondyloarthritis, a form of inflammatory arthritis in which the immune system drives inflammation in joints including the spine and where the spine meets the pelvis. Those belong with a rheumatologist, the physician who specializes in arthritis and autoimmune conditions, and are treated along a different path.
Rheumatology experts use the term inflammatory back pain for a pattern they consider relevant to classifying and diagnosing axial spondyloarthritis. In a workshop where 13 of those experts assessed 20 patients with back pain, five features best matched the experts’ own judgment that inflammatory back pain was present: the pain improves with exercise, there is pain at night, it came on gradually rather than suddenly, it started before age 40, and it does not improve with rest. When at least four of those five were present, the pattern identified 79.6% of the patients those experts judged to have inflammatory back pain and correctly cleared 72.4% of the patients they judged did not, in a separate validation group of 648 patients.3 That also means the pattern missed some patients the experts judged to have inflammatory back pain, and flagged some they judged did not.
A clinician weighs those five features alongside the rest of your history and your examination, and a single feature carries none of what that study reported. Age before 40 there means the age the pain started, not how old you are now. Joints outside the spine belong in the same conversation: swelling, warmth, or the same joint on both sides at once is something the examination asks about, and joint pain outside the spine has its own page here.
3. Sieper J, et al. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). Ann Rheum Dis. 2009;68(6):784-788. PubMed
Symptoms, and the warning signs we screen for
Facet joints sit at every level, so a report like this turns up behind low back pain, mid back pain, or neck pain, often with stiffness close to the spine and pain that changes with posture. In the neck it can spread into the shoulder blade or toward the base of the skull, which is called referred pain, meaning pain felt somewhere other than where it starts. None of that identifies the source alone; it gives the examination something specific to test.
Pain that runs in a line down a leg or an arm, or numbness, tingling, and weakness along that line, points the examination toward a nerve; down a leg, that is the pattern most people know as sciatica. Reports often describe joint changes and disc changes on the same page, a reason to have both examined together rather than sorted out on paper.
Common, and examined here
- Back or neck pain with arthritis, facet, or spondylosis wording on a report
- Pain and stiffness close to the spine rather than traveling down a limb
- Pain that changes with posture: standing and leaning back, versus sitting and leaning forward
- Stiffness after holding one position, or when you first get up
- Neck pain that spreads into the shoulder blade or toward the base of the skull
- An imaging report you have never had explained to you
Emergency, not an appointment
- New loss of bowel or bladder control
- New numbness in the groin, buttocks, or inner thighs
- Leg or arm weakness that is getting worse quickly
- New clumsiness in the hands, trouble with buttons or keys, or a walk that has become unsteady
- Back or neck pain with fever, chills, or night sweats
- New back pain after a recent spinal injection, spinal surgery, or an infection anywhere in the body
- New spine pain with a history of cancer, or with weight loss you cannot explain
- Spine pain that started right after a crash, a fall, or a blow to the spine
Loss of bowel or bladder control with groin numbness can signal cauda equina syndrome, a surgical emergency. Go to the emergency department now. Screening for every one of these is part of what an examination here does.
How we approach spinal arthritis and facet joint pain
The examination comes first: your history, a physical and neurological examination, and your imaging report read with you, not at you. Dr. Koser’s post-doctoral training in spinal MRI interpretation and clinical correlation exists for exactly this conversation, and years of helping flag potential surgical spine cases for referral, alongside neurosurgeons, came before this practice. Does what the pictures show explain the person in the room? That is what the Pain Source Exam answers.
When conservative care fits, it is built from that examination rather than from the report. The examination decides which of Dr. Koser’s four adjusting techniques belongs in your plan, and whether adjusting belongs in it at all. Alongside that sit dry needling for the muscles guarding the area, soft-tissue work, and a movement plan you can actually follow, monitored so the plan changes if you do not.
When the examination points somewhere else, we say so. A pattern that behaves like inflammatory arthritis rather than joint wear belongs with a rheumatologist. Fever with spine pain, or new spine pain with a history of cancer, belongs in front of a physician the same day. Strength that is measurably going the wrong way, or signs that point at the spinal cord itself, belongs with a specialist, and we refer you with your records.
Hurt in a car accident? Florida’s PIP law requires care to begin within 14 days. Start at our auto accident page.
What the research shows
Both of the studies below are summaries of many clinical trials rather than single experiments, and both looked at low back pain in general: not neck pain, and not pain traced to a facet joint.
In 2017, the American College of Physicians, a national physicians’ organization, published a treatment guideline for low back pain built from a systematic review of clinical trials. For chronic low back pain, meaning pain that has persisted rather than a new episode, the guideline recommended that clinicians and patients together choose treatment without medication first, a recommendation it graded as strong. The options it listed included exercise and multidisciplinary rehabilitation, a coordinated program combining physical and psychological care, which it rated as supported by moderate-quality evidence, and spinal manipulation, the hands-on joint treatment that chiropractic adjusting belongs to, which it rated as supported by low-quality evidence. Medication was not ruled out: the guideline reserved it for patients whose response to those treatments was inadequate.4 That guideline lists options; it does not rank one above another.
A 2021 review from Cochrane, an international research network that pools the trials on a question and grades how much confidence the pooled result deserves, brought together 249 randomized trials of exercise in adults whose low back pain had lasted more than 12 weeks without a specific identified cause. In that review, the average improvement in daily function with exercise was small, and it fell short of the review’s own mark for a difference patients would notice. For pain, the reviewers reached a firmer conclusion: exercise is probably effective compared with no treatment, usual care, or placebo, a conclusion they graded as moderate-certainty evidence.5 Probably is the reviewers’ own word, and it is as far as they went.
Studies like these describe groups of people with low back pain; whether their findings fit your spine, and what belongs in your plan, is what the examination works out.
4. Qaseem A, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. PubMed
5. Hayden JA, et al. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;9(9):CD009790. PubMed
Common questions about spinal arthritis and facet joint pain
What does facet arthropathy mean on my MRI report?
Arthropathy means joint condition. Facet arthropathy is the radiologist’s way of writing that the small paired joints at the back of that spinal level show wear: the cartilage lining them is thinned and the surfaces have changed shape. Facet arthrosis, facet joint osteoarthritis, and facet disease say the same thing. What it does not tell you is whether that joint is the reason you hurt.
My report says facet hypertrophy and joint space narrowing. Is that why my back hurts?
Possibly, and it runs both ways. Hypertrophy means the bone around the joint is enlarged; joint space narrowing means less gap between the two surfaces. Both describe how a joint looks, not what you feel. In one study of 252 adults with an average age of 67, low back CT changes that the study’s scale graded as severe were more common in people reporting back pain than in people who were not, and 46.7% of those reporting no back pain had those changes as well. Your pain is not less real because those words appear on other people’s reports, and whether your finding explains your symptoms is what the examination works out.
Is arthritis of the spine the same thing as rheumatoid arthritis?
No. Rheumatoid arthritis is an inflammatory, autoimmune condition, one in which the immune system drives inflammation in the joints, and it is diagnosed and managed by a rheumatologist. What most spine reports call arthritis describes the facet joints and discs in one region. Ankylosing spondylitis and the wider group called axial spondyloarthritis are inflammatory too. Telling one pattern from the other is part of what an examination screens for.
I am in my thirties. Why does my report already say degenerative changes?
Degenerative on a report describes how a joint or a disc looks in those images. It is not a statement about your age, it does not say when that appearance developed, and it does not establish what caused it. Whether the picture explains your symptoms is a separate question, and it is the one the examination answers.
I was in a car crash and now my report says arthritis. Does that mean the crash did not injure me?
A report describes what your joints look like in the images taken that day. It does not put a date on a finding or settle what caused your symptoms. What speaks to that is the rest of the record: what you could do before, what changed, and what an examination documents now. In Florida, PIP requires care to begin within 14 days; our auto accident page walks through it.
Why does my back hurt more when I stand or lean backward and feel better when I sit or lean forward?
That is a pattern people with these reports describe often, and an examination tests it directly. It does not identify the source alone: no movement, maneuver, or image does. What it does is tell the examination where to look, alongside your history, a neurological screen, and how the area responds when it is loaded and unloaded.
Can a chiropractor treat spinal arthritis, or will adjusting make it worse?
The examination decides the technique, and whether adjusting is part of the plan at all. There are four here: adjusting by hand, a drop table, an instrument that delivers a small impulse without twisting, and flexion-distraction, which stretches the spine slowly with no thrust. Some presentations are not adjusted at all; if yours is one of them, we tell you and treat differently or refer.
Do I need a facet injection or the nerve burning procedure someone mentioned?
That decision is made with the physician who performs them. A facet injection places medication into or around the joint, and the procedure people describe as nerve burning, radiofrequency ablation, uses heat on the medial branch nerves, the small nerves that carry sensation from those joints. Neither is done here. We examine you, tell you what we find, and coordinate with the physician handling that care.
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This page is general health information and is not medical advice for any individual. The studies summarized describe groups, not any one person’s outcome, and whether any finding on your imaging explains your symptoms can only be determined by examination. Talk to Dr. Bobby Koser, DC, about your own situation, and seek emergency care immediately for the warning signs listed above.
The report describes a joint. The examination is about you.
A complete examination with Dr. Bobby Koser, DC, your imaging report reviewed with you, and your findings explained the same day.