Out-of-state? Free MRI review + telehealth consult before you travel4.9 ★ · 619 Google reviewsBoard-certified — American Board of Orthopaedic SurgeryMinimally invasive, same-day spine surgery in Beverly HillsCall (424) 217-7463
Out-of-state? Free MRI review + telehealth consult before you travel4.9 ★ · 619 Google reviewsBoard-certified — American Board of Orthopaedic SurgeryMinimally invasive, same-day spine surgery in Beverly HillsCall (424) 217-7463
Facet joint disease is arthritis in the small joints that guide your spine's motion — it aches most when you lean back or twist, and it rarely needs a fusion to settle.
Behind each pair of vertebrae sit two small facet joints that link one level of the spine to the next and steer how it bends and rotates. Like any joint, they carry cartilage that can wear thin with time. When that cartilage breaks down, the facets become arthritic — inflamed, stiff, and painful — a condition known as facet joint disease.
The pain it produces is typically axial, meaning it sits in the back or neck itself rather than shooting down a limb. It tends to be worse first thing in the morning, after inactivity, and especially when you extend or twist the spine — leaning back, arching, or turning to look over your shoulder. Because these joints sit close to the nerve roots, an inflamed or enlarged facet can occasionally crowd a nerve and add radiating symptoms.
Your spine protects your spinal cord and helps absorb the forces generated by movement. Unfortunately, its complex structure and constant exposure to shock and load make it vulnerable to degeneration over time, leading to back pain. Back pain resulting from changes to the facet joints in your back is called facet joint disease or facet syndrome.
Your spine is composed of repeated “units” consisting of a vertebra, a spongy intervertebral disc, and two facet joints, one on each side of the vertebra. The disc and facet joints of each vertebra are collectively known as the “3-joint complex.” Facet joints contribute to both the stability and flexibility of your spine but are vulnerable to degenerative changes over time because of their role in absorbing forces. Weakened or degenerated facet joints no longer provide structural integrity, which can cause vertebra slippage (spondylolisthesis), disc stress or rupture, and spinal instability. Because the facet joint is well innervated (has many nerves), damage or degeneration of these joints may cause significant back pain, sometimes called facetogenic pain.
✓Pain that worsens with bending backward or twisting
✓Stiffness that is worst in the morning or after sitting
✓Tenderness directly over the spine at the affected level
✓Referred ache into the buttock, hip, or shoulder
✓Relief when leaning forward or curling slightly
The symptoms of facet joint disease can be very heterogeneous. For example, most facetogenic pain does not radiate, but you may experience pain that radiates down your legs (sciatica) if you have a synovial cyst in one of your facet joints, or in severe facet joint disease, when enlargement and inflammation of the facet joints (facet hypertrophy) is common.
Symptoms of facet joint disease may vary based on what level of your spine is affected. Most commonly, facet joint disease develops in the lumbar (low back) spine, especially the L4-L5 and L5-S1 joints. It can also occur in the cervical spine (neck). Symptoms of facet joint diseasemayinclude:
Lumbar facet joint disease sometimes causes pain that radiates to the upper thigh, buttocks, or groin, but does not extend past your knee
Back pain without any neurological symptoms (such as numbness, tingling, or foot drop)
Neck pain and cervicogenic headaches (headaches affecting the back of the head)
Causes of Facet Joint Disease
Age-related wear of the facet cartilage
Osteoarthritis of the spine
Loss of disc height that overloads the facets
Prior injury or repetitive extension and twisting
Spinal misalignment that concentrates stress on the joints
Degenerative changes to the facet joints are incredibly common, occur through the natural aging process, and may or may not cause pain. These can progress to facet joint disease over time. Factors that may contribute to facet joint disease includethefollowing:
Degenerative disc disease, which can both be caused by and contribute to facet joint disease
Inflammation, including inflammatory conditions like rheumatoid arthritis and ankylosing spondylitis
Injuries or spine trauma, including whiplash
How Is Facet Joint Disease Diagnosed?
Dr. Melamed suspects the facets when pain is centered over the spine and reliably worsens with extension and rotation. Imaging with X-ray, CT, or MRI shows the arthritic changes, but because worn facets are common and not always the pain source, confirmation often comes from a diagnostic medial branch block — a small injection that numbs the tiny nerves carrying pain from a specific facet. If that block relieves the pain, the joint is confirmed as the source and points the way to targeted treatment.
Diagnosing facet joint disease can be difficult, since many of its symptoms overlap with those of other spine conditions. At The Spine Pro in Beverly Hills, Dr. Melamed will begin by taking a thorough medical history and asking you about your symptoms. He may also perform a physical or functional exam to determine how your facet joint pain is affecting you. He may also recommend imaging, including X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI), to better understand what is causing your back pain.
Facet Joint Disease Treatment Options in Beverly Hills
Facet pain is rarely a surgical problem, so treatment is built around calming the joints and taking load off them. Dr. Melamed starts with physical therapy focused on posture and core support, anti-inflammatory measures, and activity changes. When a specific facet is confirmed as the source, an image-guided injection can quiet the inflammation and provide meaningful relief.
If the pain keeps returning, radiofrequency ablation is often the next step — a needle-based procedure that interrupts the small medial branch nerves feeding the painful facet, dialing down the signal without any open surgery. This can hold for many months, and it can be repeated. Only in the rare case where facet disease is paired with genuine instability does Dr. Melamed discuss a targeted, minimally invasive stabilization, always favoring the smallest effective intervention.
Dr. Melamed is a board-certified orthopedic spine surgeon. He specializes in holistic, noninvasive, individualized treatment for your spine problems, including facet joint disease.
At The Spine Pro, surgery is a last resort. Dr. Melamed uses a variety of holistic, noninvasive treatments for facet joint disease and will work with you to identify the best options considering your symptoms, lifestyle, and preferences. He may recommend treatments such as:
Short-term rest to allow inflammation in your facet joints to reduce
Physical therapy to strengthen the muscles in your back and improve your posture and movement patterns
Low-impact exercises like water therapy, walking, and yoga
Lifestyle modifications such as diet changes to lose weight and decrease inflammation
If you’re experiencing pain from facet joint disease, he may recommend pain control strategies like:
If your facet joint disease doesn’t respond to conservative management strategies, Dr. Melamed may recommend surgery. He is an expert in minimally invasive spine surgery and microdecompressive techniques. He will carefully review your imaging results, history, and symptoms in order to tailor his surgical recommendations to your individual needs.
Facet joint disease is unfortunately a chronic (long-term) and progressive condition. However, it can be managed. Many patients report improvement in pain and physical function after facet joint nerve ablation. Healthy lifestyle choices and appropriate treatment can reduce the stress on your facet joints, slow or prevent the progression of degeneration, and minimize your pain to allow you to return to normal life. Dr. Melamed and his staff at The Spine Pro will provide tailored support throughout your facet joint disease treatment.
What is a medial branch block and why would I need one?
It is a small injection that numbs the tiny nerves carrying pain from a specific facet joint. If it takes your pain away, we know which joint is responsible. That confirmation is what lets Dr. Melamed treat the exact source rather than guessing, and it's the step that decides whether radiofrequency ablation will help you.
Does facet joint disease require surgery?
Almost never. It is an arthritis problem, and it responds well to therapy, injections, and radiofrequency ablation of the pain-carrying nerves. Surgery only enters the picture when facet disease is combined with real instability, which is uncommon.
How long does radiofrequency ablation last?
Relief commonly lasts several months to a year or more, because the small nerves that were treated eventually regrow. When symptoms return, the procedure can be repeated. It is an appealing option precisely because it controls pain without any open surgery.
