Facet-Mediated Spinal Pain

The facet joints are paired joints at the back of the spine that contribute to spinal stability and guide movement. They can develop osteoarthritic changes, particularly with age, but degenerative findings on scans are common and do not by themselves establish that a facet joint is causing pain. Facet-mediated pain is therefore a clinical and interventional diagnosis rather than a diagnosis that can reliably be made from imaging alone.

Pain is often localised to the neck or back and may be aggravated by extension or rotation, with possible referral into the buttock, shoulder or proximal limb. These features are not specific, however, and examination findings alone cannot reliably identify the painful facet joint. In appropriately selected patients, image-guided medial branch blocks can provide prognostic information about whether radiofrequency denervation is likely to help.

When a patient has a convincing response to appropriately performed diagnostic medial branch blocks, radiofrequency denervation can provide meaningful relief for selected patients, often for several months or longer, although outcomes vary. Exercise, physical rehabilitation and management of contributing factors remain important. Imaging is used when clinically indicated rather than simply to prove the presence of facet degeneration.