Spinal Facet Syndrome

The facet joints are small, cartilage-lined joints that link each vertebra to the one above and below it. They guide and limit motion. When the cartilage thins or the joint capsule becomes inflamed, the joint itself becomes a pain generator — a pattern known as facet syndrome or facet arthropathy.

Facet pain is typically axial: it stays in the neck or low back and the immediately surrounding muscles rather than shooting down an arm or leg. It often worsens with leaning backward, standing for long periods or rolling over in bed, and eases when you sit or bend forward.

Because imaging frequently shows facet changes in people with no pain at all, diagnosis depends on the examination and, when appropriate, a diagnostic medial branch block that temporarily numbs the nerves supplying a specific joint.

Your evaluation starts with a history focused on what makes the pain better or worse. Facet pain classically eases with sitting or bending forward and worsens with standing up straight, leaning backward, or twisting. The exam looks for tenderness directly over the joints and pain reproduced with extension and rotation.

X-ray or MRI can show joint changes, but those changes are extremely common in people with no pain, so imaging alone cannot confirm the diagnosis. The most reliable test is a diagnostic medial branch block, a small injection of numbing medicine near the nerves that supply the suspected joint.

If the block relieves your usual pain for the expected duration of the anesthetic, the joint is confirmed as the source, and longer-lasting treatment such as radiofrequency ablation can be planned with confidence rather than guesswork.