Facet Hypertrophy

Facet hypertrophy, or facet joint hypertrophy, happens when the small joints called facets between your spine bones (vertebrae) enlarge and inflame. It’s often due to wear and tear. These joints help stabilize your spine and guide movement. Cartilage is the smooth tissue covering the ends of your facet joints. Aging or overuse can wear it down. This lets bone rub on bone and triggers joint overgrowth.

Facet hypertrophy can cause pain, stiffness or spasms. A healthcare provider can help you manage these issues so they interfere less with your daily routine.

Where does facet hypertrophy happen?

Facet joints run all along your spine. They’re found in each segment, including your:

• Neck (cervical spine)
• Mid-back (thoracic spine)
• Lower back (lumbar spine)

Each level of your spine has two facet joints, one on each side. Your provider may describe the location as:

• Bilateral: Affecting both sides
• Unilateral: Affecting one side

Facet hypertrophy symptoms

Not all cases of facet joint hypertrophy cause symptoms, but facet joint hypertrophy from wear and tear can be a source of pain. You may notice:

• Aching, dull or throbbing pain at the joint
• Pain or discomfort when standing for a while, arching your back, leaning or twisting
• Reduced range of motion
• Spasms
• Stiffness
• Tenderness to the touch

Pain from these joints may also appear in other areas of your body. This is called referred pain. It means you feel it somewhere different from where the pain starts. Pain can also radiate, or spread, from the joint itself. Pain from the facet joints can radiate to your butt and thighs. Keep in mind, this pain won’t radiate below your knee.

Many people find the pain feels worse after rest, like first thing in the morning. But it may improve with gentle movement.

Facet hypertrophy causes

Facet hypertrophy happens when a facet joint breaks down. This occurs as the cartilage that lines and cushions your spinal bones wears away over time. Everyone’s spine changes with age, but other factors can also play a role, including:

• Overweight or obesity
• Poor posture
• Previous spine injuries
• Repetitive strain from heavy lifting

Complications of facet hypertrophy

Your spinal canal (the bony tunnel that holds your spinal cord) has limited space. If a facet joint grows too large, it may cause your spinal canal to narrow, and it can press on nearby nerves or your spinal cord. Fluid-filled cysts can also form near your joint. In some cases, joint degeneration can cause slippage of one vertebra over another (spondylolisthesis).

These changes can affect both movement and feeling. You may notice trouble walking, numbness or weakness in your arms and legs. In severe cases, it may also cause bowel or bladder problems. These symptoms are important to watch for, so let your provider know if they happen.

How doctors diagnose facet hypertrophy

A healthcare provider usually starts with a physical exam and a review of your medical history. They’ll ask about your symptoms. They may gently press on your spine to check where the pain comes from or have you do different movements to see what creates the pain.

To get a better look at your joints, your provider may order imaging tests like x-rays, a CT scan or MRI. The imaging test helps your provider see the enlarged joint to confirm the diagnosis.

What are the stages of facet joint hypertrophy?

Imaging tests can show how much a facet joint thickens. Your provider may grade it as mild, moderate or severe. This grading helps guide treatment and track changes over time. Keep in mind that a worse grade doesn’t always mean worse pain. It’s just describing how it looks in the images.

Facet hypertrophy treatment

Treatment depends on how severe the condition is. Options may include:

• At-home care: You might try using heat or ice on the affected area for a short period, sitting in a supportive chair or avoiding strenuous activities that involve bending and twisting.
• Physical therapy: Exercises strengthen the muscles around your back and core to support your spine.
• Medications: NSAIDs (like ibuprofen or naproxen) or acetaminophen relieve pain. Muscle relaxants may ease spasms.
• Radiofrequency ablation: A probe uses heat to block the nerves that carry pain signals from the joint. Relief is temporary.
• Surgery: This option is rare but may help if other treatments don’t work. A surgeon may decompress the affected area by removing part of the bone or tissue pressing on nerves.
• Emerging technology: A provider may temporarily place peripheral nerve stimulators (PNS) next to the nerves that carry pain signals from your joints. This interrupts pain signals and reprograms how you feel the pain. Relief is temporary.

When should I see my healthcare provider?

See a healthcare provider if you have ongoing back or neck pain. Let them know if it doesn’t improve or gets worse after home care, like rest or over-the-counter pain relievers.

Get medical help right away if you notice sudden weakness or numbness in your arms or legs, or if you have changes in bowel or bladder function.

What can I expect if I have facet hypertrophy?

There isn’t a single experience that fits everyone. You might not have any symptoms, only have mild symptoms or have severe ones that affect your daily routine.

Joint changes from arthritis are usually permanent. The condition may slowly get worse. Even though treatment can’t reverse the damage, it can help manage symptoms if you have them. You may need small lifestyle adjustments and occasional treatments throughout the year to manage your symptoms.

A healthcare provider can help you find the treatment plan that works best for you.

Can facet hypertrophy be prevented?

You can’t fully prevent facet joint hypertrophy because your facet joints naturally wear down over time. But you can lower your risk by:

• Maintaining a weight that’s healthy for you
• Practicing good posture
• Strengthening your core muscles to support your spine
• Using proper lifting techniques for heavy objects