Table of ContentsView AllTable of ContentsAnatomyCausesSymptomsDiagnosisTreatmentOutlookCoping
Table of ContentsView All
View All
Table of Contents
Anatomy
Causes
Symptoms
Diagnosis
Treatment
Outlook
Coping
Facet hypertrophy is when the joints that help articulate the spinal column—called facet joints—become enlarged, resulting in pain, stiffness, and a reduced range of motion. There are many possible causes of facet hypertrophy, includingarthritis, a back injury, or simply the natural aging process.
Facet hypertrophy is achroniccondition that progresses with age. When diagnosed, facet hypertrophy can be treated with pain medications, massage therapy, a nerve block, or a procedure called neurolysis which ablates (destroys) nerves to relieve pain.
Although there is no cure for facet hypertrophy, the appropriate treatment can reduce symptoms, slow disease progression, and improve a person’s quality of life.
gilaxia / Getty Images
What Is Facet Hypertrophy?
Facet hypertrophy, also known as facet syndrome, is a common condition in which the facet joints in the spine become enlarged.Facet jointsare the connection between spinal bones (calledvertebrae) that stabilize the spine during bending and twisting motions.
The facet joints are located on the symmetrical wing-shaped structure on the back of each vertebra called aspinous process. The two points where the spinous process of the upper vertebra comes into contact with the spinous process of the lower vertebra are the facet joints. There are two facet joints for every vertebra, one stacked atop the next.
The primary function of facet joints is to guide and limit the movement of the spinal column based on the angle and height of each paired joint.When the facet joints are enlarged due to hypertrophy, this function is limited or compromised.
What Causes Facet Joints to Enlarge?
Facet joints can become abnormally enlarged for any number of reasons. This can not only causemusculoskeletal painbut alsoneuropathic (nerve) paindue to the compression of spinal nerves. Neuropathic pain can also lead toreferred painin which you feel burning, aching, or shooting pain in another part of the body.
The main causes of facet hypertrophy include spinal degeneration, synovial inflammation, and joint instability or injury.
Spondylosis
Spondylosis, also known asosteoarthritis (OA)of the spine, is the most common cause of facet joint hypertrophy.
With facet hypertrophy, the wear and tear of the joint can lead to abnormal bone remodeling and the gradual enlargement of the joint on one or both sides.
Risk factors for spondylosis include:
Synovial Inflammation
There are also inflammatory causes of facet hypertrophy that can cause joint enlargement and pain. These conditions mainly affect the synovial capsules surrounding the facet joints.
When exposed to inflammatory compounds like cytokines or growth factors, bone turnover and growth can accelerate, leading to facet hypertrophy.
Two of the most common causes of this include:
Joint Instability or Trauma
The acute injury, in turn, can contribute to an increased risk of spondylosis later in life.
What Does Facet Hypertrophy Feel Like?
Facet hypertrophy symptoms can vary in intensity and location, depending on which vertebrae or spinal nerves are affected. Although thelumbar spinelocated in the lower back is most commonly affected, thecervical spineof the neck can also be involved.
Facet hypertrophy may be unilateral (affecting only one joint on the adjacent vertebrae) or bilateral (affecting both joints on the adjacent vertebrae).
The symptoms of facet hypertrophy may also be felt in other parts of the body, including the buttocks, groin, thighs, neck, and shoulder.
Symptoms of facet hypertrophy may include:
The diagnosis of facet hypertrophy will start with a physical examination and a review of your medical history and symptoms.
As part of the physical exam, you may be asked to move into positions to determine at which point pain occurs. This includes the Kemp’s maneuver in which your healthcare provider holds your shoulders while you are standing and extends and rotates your spine to trigger pain.
The following imaging tests can show certain aspects of visible damage to support the diagnosis:
Nerve conduction studies (NCS)can determine if there is sensory nerve compression based on electrical activity in nerves.
Facet hypertrophy can be confirmed with adiagnostic nerve block. This involves administering an anesthetic injection into the affected joint. Immediate pain relief confirms that the facet joint is the source of pain.
Differential Diagnosis
Facet hypertrophy can be challenging to diagnose as it can mimic many other conditions, including:
Because of this, additional tests may be needed to exclude these conditions and definitively diagnose facet joint hypertrophy as the cause.
There is no cure for facet hypertrophy, and it doesn’t go away on its own. The goal of treatment is to make the pain more manageable and improve joint mobility. Conservative treatment is usually successful in making a difference.
Conservative Management
First-line treatment involves the following conservative therapies:
Medial Branch or Facet Block
Amedial branch blockinjects local anesthetic near the small medial nerves that connect to an inflamed facet joint. Medial nerves are the small nerves outside the joint space near the nerve that carry pain messages and other impulses from your facet joints to your brain.
A facet block injects the medication outside the joint space near the nerve that supplies the joint. This nerve is called the medial branch.
Neurolysis
Neurolysis, also calledrhizotomyor neurotomy, is a procedure that destroys affected nerve fibers to achieve pain relief, reduce disability, and reduce the need fororal or injected painkillers. This treatment can reduce pain for six to 12 months until the nerves regenerate. Further treatments may be needed at that time.
Neurolysis can be performed using one of the following techniques toablate(destroy) the affected nerves:
Surgery
Examples include:
Prognosis
Facet hypertrophy is a chronic condition that progresses with age. The disorder is incurable, but symptoms often respond well to conservative therapies. Facet hypertrophy does not affect life expectancy.
Your healthcare provider can help you determine a treatment plan based on the extent and location of the facet joint affected. Early diagnosis and treatment can help you achieve the best results.
Coping and Living Well
Most people can manage the pain of facet hypertrophy with conservative treatment. However, avoiding certain sports and other activities that cause pain may also be necessary. This can allow time for the inflammation to subside.
Maintaining an active lifestyle and healthy weight can help prevent further stress on the joints. You may have to perform regularstretchingand strengthening exercises for the rest of your life to lower inflammation, reduce stress, and improve your overall health.
Summary
Facet hypertrophy is an incurable, chronic disease that affects the facet joints in your spine. Non-inflammatory conditions like osteoarthritis and inflammatory conditions like ankylosing spondylitis can cause abnormal or accelerated bone growth, leading to pain and a loss of range of motion. Spinal trauma can also lead to facet hypertrophy.
Facet hypertrophy generally worsens over time, though treatment can help you manage pain and slow disease progress. Most cases respond well to conservative treatment. Severe cases may require nerve ablation or spinal surgery.
17 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.University of Maryland Medical Center.A patient’s guide to anatomy and function of the spine.Colloca L, Ludman T, Bouhassira D, et al.Neuropathic pain.Nat Rev Dis Primers. 2017;3:17002. doi:10.1038/nrdp.2017.2Perolat R, Kastler A, Nicot B, et al.Facet joint syndrome: from diagnosis to interventional management.Insights Imaging. 2018 Oct;9(5):773-789. doi:10.1007/s13244-018-0638-xNational Institute on Aging.Osteoarthritis.Mi B, Xiong Y, Knoedler S, et al.Ageing-related bone and immunity changes: insights into the complex interplay between the skeleton and the immune system.Bone Res.2024;12:42. doii:10.1038/s41413-024-00346-4National Institute of Arthritis and Musculoskeletal and Skin Diseases.Ankylosing spondylitis.American College of Rheumatology.Rheumatoid arthritis.American Academy of Orthopaedic Surgeons.Spondylolysis and spondylolisthesis.Weill Cornell Medicine Brain & Spine Center.Symptoms of facet syndrome.Cedars Sinai.Facet joint syndrome.Weill Cornell Medicine Brain & Spine Center.Diagnosing and treating facet syndrome.Brigham and Women’s Hospital.Facet and medial branch blocks.Smuck M, Crisostomo RA, Trivedi K, Agrawal D.Success of initial and repeated medial branch neurotomy for zygapophysial joint pain: a systematic review.PM&R. 2012;4(9):686-692. doi;10.1016/j.pmrj.2012.06.007Ozer AF, Suzer T, Sasani M, et al.Simple facet joint repair with dynamic pedicular system: technical note and case series.Journal of Craniovertebral Junction and Spine. 2015;6(2):65.Health Quality Ontario.Cervical artificial disc replacement versus fusion for cervical degenerative disc disease: a health technology assessment.Ont Health Technol Assess Ser. 2019;19(3):1-223.American Academy of Orthopaedic Surgeons.Spinal fusion.Knappe UJ, Reinecke D, Florke M, Horn P, Schonmayr R.Facet joint replacement: intermediate- and long-term outcome in a large case series.J Neurol Surg A Cent Eur Neurosurg.2021 Jan;82(1):34-42. doi:10.1055/s-0040-1716534
17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.University of Maryland Medical Center.A patient’s guide to anatomy and function of the spine.Colloca L, Ludman T, Bouhassira D, et al.Neuropathic pain.Nat Rev Dis Primers. 2017;3:17002. doi:10.1038/nrdp.2017.2Perolat R, Kastler A, Nicot B, et al.Facet joint syndrome: from diagnosis to interventional management.Insights Imaging. 2018 Oct;9(5):773-789. doi:10.1007/s13244-018-0638-xNational Institute on Aging.Osteoarthritis.Mi B, Xiong Y, Knoedler S, et al.Ageing-related bone and immunity changes: insights into the complex interplay between the skeleton and the immune system.Bone Res.2024;12:42. doii:10.1038/s41413-024-00346-4National Institute of Arthritis and Musculoskeletal and Skin Diseases.Ankylosing spondylitis.American College of Rheumatology.Rheumatoid arthritis.American Academy of Orthopaedic Surgeons.Spondylolysis and spondylolisthesis.Weill Cornell Medicine Brain & Spine Center.Symptoms of facet syndrome.Cedars Sinai.Facet joint syndrome.Weill Cornell Medicine Brain & Spine Center.Diagnosing and treating facet syndrome.Brigham and Women’s Hospital.Facet and medial branch blocks.Smuck M, Crisostomo RA, Trivedi K, Agrawal D.Success of initial and repeated medial branch neurotomy for zygapophysial joint pain: a systematic review.PM&R. 2012;4(9):686-692. doi;10.1016/j.pmrj.2012.06.007Ozer AF, Suzer T, Sasani M, et al.Simple facet joint repair with dynamic pedicular system: technical note and case series.Journal of Craniovertebral Junction and Spine. 2015;6(2):65.Health Quality Ontario.Cervical artificial disc replacement versus fusion for cervical degenerative disc disease: a health technology assessment.Ont Health Technol Assess Ser. 2019;19(3):1-223.American Academy of Orthopaedic Surgeons.Spinal fusion.Knappe UJ, Reinecke D, Florke M, Horn P, Schonmayr R.Facet joint replacement: intermediate- and long-term outcome in a large case series.J Neurol Surg A Cent Eur Neurosurg.2021 Jan;82(1):34-42. doi:10.1055/s-0040-1716534
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
University of Maryland Medical Center.A patient’s guide to anatomy and function of the spine.Colloca L, Ludman T, Bouhassira D, et al.Neuropathic pain.Nat Rev Dis Primers. 2017;3:17002. doi:10.1038/nrdp.2017.2Perolat R, Kastler A, Nicot B, et al.Facet joint syndrome: from diagnosis to interventional management.Insights Imaging. 2018 Oct;9(5):773-789. doi:10.1007/s13244-018-0638-xNational Institute on Aging.Osteoarthritis.Mi B, Xiong Y, Knoedler S, et al.Ageing-related bone and immunity changes: insights into the complex interplay between the skeleton and the immune system.Bone Res.2024;12:42. doii:10.1038/s41413-024-00346-4National Institute of Arthritis and Musculoskeletal and Skin Diseases.Ankylosing spondylitis.American College of Rheumatology.Rheumatoid arthritis.American Academy of Orthopaedic Surgeons.Spondylolysis and spondylolisthesis.Weill Cornell Medicine Brain & Spine Center.Symptoms of facet syndrome.Cedars Sinai.Facet joint syndrome.Weill Cornell Medicine Brain & Spine Center.Diagnosing and treating facet syndrome.Brigham and Women’s Hospital.Facet and medial branch blocks.Smuck M, Crisostomo RA, Trivedi K, Agrawal D.Success of initial and repeated medial branch neurotomy for zygapophysial joint pain: a systematic review.PM&R. 2012;4(9):686-692. doi;10.1016/j.pmrj.2012.06.007Ozer AF, Suzer T, Sasani M, et al.Simple facet joint repair with dynamic pedicular system: technical note and case series.Journal of Craniovertebral Junction and Spine. 2015;6(2):65.Health Quality Ontario.Cervical artificial disc replacement versus fusion for cervical degenerative disc disease: a health technology assessment.Ont Health Technol Assess Ser. 2019;19(3):1-223.American Academy of Orthopaedic Surgeons.Spinal fusion.Knappe UJ, Reinecke D, Florke M, Horn P, Schonmayr R.Facet joint replacement: intermediate- and long-term outcome in a large case series.J Neurol Surg A Cent Eur Neurosurg.2021 Jan;82(1):34-42. doi:10.1055/s-0040-1716534
University of Maryland Medical Center.A patient’s guide to anatomy and function of the spine.
Colloca L, Ludman T, Bouhassira D, et al.Neuropathic pain.Nat Rev Dis Primers. 2017;3:17002. doi:10.1038/nrdp.2017.2
Perolat R, Kastler A, Nicot B, et al.Facet joint syndrome: from diagnosis to interventional management.Insights Imaging. 2018 Oct;9(5):773-789. doi:10.1007/s13244-018-0638-x
National Institute on Aging.Osteoarthritis.
Mi B, Xiong Y, Knoedler S, et al.Ageing-related bone and immunity changes: insights into the complex interplay between the skeleton and the immune system.Bone Res.2024;12:42. doii:10.1038/s41413-024-00346-4
National Institute of Arthritis and Musculoskeletal and Skin Diseases.Ankylosing spondylitis.
American College of Rheumatology.Rheumatoid arthritis.
American Academy of Orthopaedic Surgeons.Spondylolysis and spondylolisthesis.
Weill Cornell Medicine Brain & Spine Center.Symptoms of facet syndrome.
Cedars Sinai.Facet joint syndrome.
Weill Cornell Medicine Brain & Spine Center.Diagnosing and treating facet syndrome.
Brigham and Women’s Hospital.Facet and medial branch blocks.
Smuck M, Crisostomo RA, Trivedi K, Agrawal D.Success of initial and repeated medial branch neurotomy for zygapophysial joint pain: a systematic review.PM&R. 2012;4(9):686-692. doi;10.1016/j.pmrj.2012.06.007
Ozer AF, Suzer T, Sasani M, et al.Simple facet joint repair with dynamic pedicular system: technical note and case series.Journal of Craniovertebral Junction and Spine. 2015;6(2):65.
Health Quality Ontario.Cervical artificial disc replacement versus fusion for cervical degenerative disc disease: a health technology assessment.Ont Health Technol Assess Ser. 2019;19(3):1-223.
American Academy of Orthopaedic Surgeons.Spinal fusion.
Knappe UJ, Reinecke D, Florke M, Horn P, Schonmayr R.Facet joint replacement: intermediate- and long-term outcome in a large case series.J Neurol Surg A Cent Eur Neurosurg.2021 Jan;82(1):34-42. doi:10.1055/s-0040-1716534
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