From the Guidelines
Facet joint arthritis in the lumbar spine should be managed with a multimodal approach, prioritizing conservative treatments and reserving interventional procedures for patients who do not respond to initial management, as recommended by the most recent guideline from 2025 1.
Initial Management
Treatment typically begins with conservative approaches, including:
- Over-the-counter pain medications like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or NSAIDs such as ibuprofen (400-800mg three times daily with food) for pain relief 1.
- Physical therapy focusing on core strengthening, flexibility, and proper body mechanics is essential for long-term management.
- Applying heat for 15-20 minutes several times daily to relax muscles and improve blood flow.
- Weight management is important as excess weight increases stress on these joints.
Interventional Procedures
For persistent pain, medical interventions may include:
- Facet joint injections with corticosteroids and local anesthetic.
- Medial branch blocks.
- Radiofrequency ablation, which can provide relief for 6-12 months, as supported by the 2013 guideline from the British Journal of Anaesthesia 1. These treatments work by addressing inflammation in the joints and reducing pain signals from the affected nerves.
Preventing Symptom Flare-ups
Maintaining good posture, avoiding prolonged sitting, and using proper lifting techniques can help prevent symptom flare-ups. It is essential to note that the 2025 guideline from the BMJ 1 emphasizes the importance of a careful appraisal of the full body of evidence to produce guidance that optimizes the concordance between evidence and clinical use of interventional procedures for chronic spine pain.
From the Research
Arthritis of Facet Joint of Lumbar Spine
- Facet joint arthritis is a common cause of chronic low back pain, accounting for 15-45% of cases 2
- The diagnosis of facet joint arthritis can be challenging, and imaging studies such as radiographs, MRI, CT, and SPECT may not always correlate with clinical symptoms 2
- Diagnostic facet joint blocks can help confirm the diagnosis and indicate the source of pain 3, 2
Diagnostic and Therapeutic Options
- Fluoroscopic or computed tomography (CT) guidance is recommended for all facet joint interventions, with a level of evidence I and strong strength of recommendation 3
- Lumbar diagnostic facet joint nerve blocks have a level of evidence I to II, with moderate to strong strength of recommendation 3
- Therapeutic options for facet joint arthritis include radiofrequency ablation, facet joint nerve blocks, and intraarticular injections, with varying levels of evidence and strength of recommendation 3, 4, 5
Treatment Outcomes
- Steroid injections can promote a reduction in pain and improvement in functional outcomes, with a reduction in numeric rating scale (NRS) by 28% and improvement in Oswestry Disability Index (ODI) by 13.2% 5
- Local anaesthetics and sarapin can also produce improvements in pain and functional outcomes, with varying degrees of evidence and strength of recommendation 5
- Radiofrequency ablation is a preferred method for denervation of the facet joint, with a level of evidence II and moderate strength of recommendation 3, 4