Bilateral Facet Arthropathy: Causes, Symptoms & Treatment Options

Bilateral facet arthropathy is degenerative osteoarthritis affecting the facet (zygapophyseal) joints on both sides of the spinal segment. These synovial joints guide and limit spinal motion; degeneration leads to pain, stiffness, and reduced mobility.

Etiology & Risk Factors

• Age‑related wear and tear (primary osteoarthritis)
• Mechanical stress: obesity, repetitive loading, heavy labor
• Systemic conditions: diabetes, rheumatoid arthritis, ankylosing spondylitis
• Prior trauma or spinal surgery

Clinical Features

• Axial back or neck pain (unilateral or bilateral)
• Pain worsened by extension, rotation, or prolonged standing
• Morning stiffness <30 minutes
• Tenderness over affected facet joints
• Referred pain to buttock, thigh, or shoulder (pseudoradicular)

Diagnosis

• History and physical exam (facet loading maneuvers)
• Imaging: X‑ray (joint space narrowing, osteophytes), CT (bony detail), MRI (soft tissue, nerve compression)
• Diagnostic medial branch blocks confirm pain source.

Management

1. Conservative: NSAIDs, physical therapy (core strengthening, posture), activity modification, weight loss.
2. Interventional: Intra‑articular corticosteroid injections; medial branch radiofrequency ablation (RFA) for longer relief.
3. Surgical: Facet joint fusion (rare, for instability or refractory pain).

Prognosis

Chronic but manageable. Multimodal approach yields best functional outcomes.