Facet joint treatment, or zygapophyseal joint treatment, aims to reduce pain, improve spinal mobility and restore function in daily activities.
The facet joints are small posterior joints of the spine that contribute to the stability and control of spinal movement. When affected by overload, osteoarthritis, inflammation or degeneration, they can become a significant source of neck, thoracic or low back pain.
The management of facet joint pain must be gradual and tailored to the individual.
Treatment generally begins with conservative measures, reserving interventional procedures for cases in which pain persists despite an adequate course of rehabilitation and medication.
Conservative treatment
The first phase of treatment involves non-invasive measures.
Complete bed rest is generally not recommended; it is preferable to maintain controlled physical activity, avoiding movements that increase pain, such as forced extension, sudden rotations or excessive loads.
Physical therapy plays a central role.
The exercises aim to improve spinal mobility, strengthen the paravertebral and abdominal muscles, correct any postural imbalances and reduce overload on the posterior joints. Manual techniques, stretching, postural education and functional rehabilitation programs can also be useful.
From a pharmacological standpoint:
analgesics, non-steroidal anti-inflammatory drugs, muscle relaxants or other medications for pain control may be used, always based on clinical assessment and the patient’s condition.
Medication should be regarded as temporary support, not the sole therapeutic strategy.
Joint injections
When pain persists, facet joint injections may be used.
The procedure involves injecting a local anesthetic, sometimes combined with a corticosteroid, directly into the joint or near the nerves that supply it. These injections can have both therapeutic and diagnostic value, as they help confirm that the facet joint is indeed the source of the pain.
Injections must be performed with radiological, ultrasound, fluoroscopic or CT guidance, to increase precision and reduce the risk of complications.
The benefits can be temporary and variable: in some patients relief lasts weeks or months, while in others the response is more limited.
Medial branch block
An important role is played by the medial branch block, which targets the small nerves that transmit pain from the facet joints.
The procedure involves injecting a local anesthetic near the affected nerve branches. If the block produces a significant reduction in pain, it can confirm the facet origin of the symptoms and guide the choice toward longer-lasting treatments, such as radiofrequency.
Facet joint radiofrequency
Radiofrequency, or radiofrequency neurotomy/denervation, is a minimally invasive procedure that uses controlled heat to temporarily interrupt pain transmission along the medial branches.
It does not “cure” osteoarthritis or joint degeneration, but it can reduce pain for an extended period, allowing the patient to move better and take part more effectively in rehabilitation.
Available evidence supports the use of lumbar radiofrequency in selected patients, especially after diagnostic confirmation through medial branch blocks.
Surgery
Surgery is not the standard treatment for isolated facet joint pain.
It may be considered only in specific situations, for example in the presence of spinal instability, significant stenosis, spondylolisthesis or associated neurological compression.
In these cases, treatment is not directed solely at the painful facet, but at the overall spinal condition.
Treatment goals
Facet joint treatment should not be understood merely as pain reduction.
The most important goal is to improve function: walking better, sleeping better, reducing stiffness, increasing exertion tolerance and preventing recurrence. For this reason, even when injections or radiofrequency are effective, it is essential to combine them with a rehabilitation program and address the factors contributing to overload, such as a sedentary lifestyle, muscle weakness, poor posture, excess weight or repetitive movements.
Facet joint treatment should follow a progressive approach: starting with conservative measures, then, if needed, moving to injections or interventional procedures in selected cases.
The choice of therapy depends on the location of the pain, the duration of symptoms, the response to previous treatments, diagnostic imaging and, above all, the clinical assessment of the patient.
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