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Facet Hypertrophy — Common Symptoms, Diagnosis & Treatment

Deuk Spine Web Team
An expert in all things spine, Dr. Deukmedjain is a board certified neurosurgeon who has performed thousands of minimally invasive surgeries and procedures including the revolutionary Deuk Laser Disc Repair and the Deuk Spinal Fusion. 

The small, angular facet joints are on either side of the ring-shaped bones surrounding the vertebral bodies. These joints play an essential role in stabilizing spinal movement. Vertebrae range of motion depends on the angle and height of the facets and their placement on the segment. As a result, your spine’s flexibility and movement direction will vary for each region (e.g., neck, neck, cervical, or upper back).

If you or a loved one is experiencing any of the facet hypertrophy symptoms outlined in this article, it’s time to get a FREE Consultation and MRI Review with Deuk Spine Institute. We will help relieve your pain and get you back to living without limitations!

What is Facet Hypertrophy, and how can it be prevented?

When these vertebral joints widen, it is called facet hypertrophy. As the cartilage wears away, the vertebral joint becomes wider. The cartilage protects the bones from friction and distributes pressure evenly across the bone. For example, prolonged, extreme stress on the joints can cause cartilage wear.

Wearing out the vertebral joints can cause back pain and limit spinal movement. In addition, vertebral joint wear can cause nerve irritations or damage to the area around the spinal joints. An increase in swelling at the facet joint may cause pain and discomfort. Facet hypertrophy, if left untreated, can lead to spinal Stenosis or radiculopathy.

Facet Hypertrophy Symptoms

Different people may experience facet joint disease — some people may experience only mild pain while others may be unable to move. However, facet hypertrophy can cause severe symptoms and painful reactions dependent on the severity and extent of the damage to the joint, the degree of the swelling, and the pressure on the nerves surrounding the affected area.

For example, symptoms such as headaches and facet degeneration in your upper back can cause pain in the neck and shoulders. You should also be aware of the following signs:

  • Pain in the Back
  • Feeling hurt and difficulty while arching your back
  • Stability of the spine
  • Pain in the legs or buttocks
  • Activity increases intensity and pain

Facet Hypertrophy Causes

Various factors can cause facet joint swelling, and degenerative diseases or sports injuries can also cause this condition. Lifestyle choices may also play a role. In addition, there are many other possible causes of facet hypertrophy.

  • Traumatic injury results from a car, sport, or fall accident.
  • Inactivity or inactivity due to lack of exercise
  • Overweight and obesity
  • Spinal fractures
  • Poor posture
  • Repetitive twisting and bending
  • Ligament torn

Comorbid conditions can exacerbate facet hypertrophy. For example, disc degeneration is a rupture of the cushioning discs between the spinal vertebrae, which puts excessive pressure on the facet joints. The process of cartilage atrophy is then accelerated. Additionally, Spondylolisthesis can increase pressure on a damaged facet joint.

Osteophytes and bone spurs can also contribute to facet hypertrophy. Bone spurs are the result of bone-on-bone contact. The friction signals the body’s ability to create bone projections to heal the affected area.

Lumbar Facet Hypertrophy

Facet hypertrophy can often occur in the lumbar region of the spine or lower back. For example, your lower back may become stiff when you lean backward with reduced mobility. In addition, facet hypertrophy can cause pain in the lower back and radiate down to the hip, buttock, and upper thigh.

Diagnosing Hypertrophic Facial Disease

It can be challenging to determine the source of pain symptoms as facet hypertrophy symptoms look similar to spinal Stenosis or herniated disk. However, the origin of the pain can be confirmed using imaging techniques and a medial block test. A medial branch block is a pain relief injection that temporarily relieves pain symptoms in your spine’s medial branch nerve. These nerves connect to the facet joint, so if you feel pain relief after an MBB, the area injected with facet joints is the cause of pain.

Diagnostic tests for Facet Hypertrophy

Facet arthropathy diagnosis requires that you describe your symptoms during a physical exam. You must express your symptoms at a physical exam to diagnose facet arthropathy. Computerized Tomography A CT scan can visualize the spine. A CT scan can reveal more detail than an X-ray and show damage to the nerves or spinal cord.

EMG/NCS Electromyogram/NCS: Nerve conduction studies and nerve electromyograms may examine nerve and muscle tissue’s electrical activity — information about nerve damage, sensory nerve compression, and so on.

MRI scanner: Magnetic resonance imaging(MRI) uses radiofrequency waves and magnetic fields to create a detailed image that shows the spine — including discs, nerves, and skin. Contrast agents can sometimes be injected into tissues and structures to highlight specific details. MRIs can also show past injuries.

The Deuk Spine Institute specialists will provide individualized treatment and care plans for each person diagnosed with facet hypertrophy after the confirmed diagnosis.

Facet Hypertrophy Treatment

Although diagnosing a facet condition is often the first thing your doctor does, treatment is the final goal. Non-invasive conservative treatments are the best option. Surgical procedures and injections are available if these methods don’t alleviate symptoms. Therefore, finding a doctor who specializes in treating facet hypertrophy is essential. Usually, neurosurgeons are well-suited for dealing with nerve conditions such as facet disease.

Facet Disease: Home Exercise and Physiotherapy

Facet disease treatment includes both home exercise and physiotherapy. Joints are better supported by strengthening the ligaments and muscles surrounding your spine. In addition, medication can help relieve pain. Tramadol and other opiates may be helpful in acute pain relief. A facet injection is another option — a numbing drug and a cortisone steroid that reduces inflammation to provide long-term pain relief.

Facet Hypertrophy Surgeries

Facet hypertrophy is treatable with surgery. After your diagnosis is confirmed, there are several options that your doctor may discuss with you. They will also walk you through the pros of each procedure.

Endoscopic Spinal Decompression

Over-the-counter pain medication such as ibuprofen and acetaminophen during rehabilitation helps. After we have reviewed your case and exhausted all other options, we may recommend spinal decompression.

This procedure involves a small incision measuring about 1/2 inch. The tiny camera, called an endoscope, is inserted into the muscle. It moves around but not through. The small surgical instruments remove obstructed bone and open the nerve passageways to relieve the pain. This procedure is also known as a minimally invasive laminectomy.

Minimally Invasive Spinal Fusion

Spinal Fusion involves the addition of bone grafting and implants to prevent the affected vertebrae from rubbing against one another — preventing nerve impingement and relieving pain. This minimally invasive procedure offers many benefits: smaller incisions won’t cut muscle, less scarring, and faster recovery.

Doctors who treat Facet Syndrome

Patients with back pain should see their primary physician first. If you suspect that you have facet hypertrophy, it is crucial to seek immediate consultation at a spine center. It is possible to prevent its progression by getting early intervention.

The Deuk Spine Institute has skilled and world-renowned spine surgeons — including neuro-spine surgeon Dr. Ara Deukmedjian, MD — as well as pain management specialists to offer comprehensive care.

Many times, we start with non-surgical and minimally invasive methods. We offer minimally invasive surgery for patients who require it. We aim to speed up your recovery, reduce pain and minimize downtime.

History and Epidemiology

Facet hypertrophy, a condition where the facet joints of the spine become larger, is common. The spine’s synovial joints are called facet joints, where the two vertebrae meet. They stabilize the spine when it is bent or turned.

Facet hypertrophy may be unilateral or bi-directional and can occur for many reasons, including injury, arthritis, or aging.

Facet hypertrophy is a condition that can lead to a variety of problems, including stiffness, pain, and decreased range of motion. The prevalence of low back pain caused by facet joint involvement is between 15% and 45%.

Etiology and Risk Factors

Spondylosis, or spine degeneration, is the leading cause of facet joint diseases. Osteoarthritis is the result of natural wear and tear. This process involves cytokines as well as proteolytic enzymes. Finally, facet hypertrophy happens by trauma from falls, sports injuries, or car accidents.

Facet hypertrophy occurs with inflammation of the synovium. Ankylosing and rheumatoid arthritis are two conditions that can cause inflammation of the synovial fluid. Spondylolisthesis is a condition that causes instability of the spine and may contribute to facet hypertrophy. Subluxation of the facet joint may also occur.

Some of the risk factors for facet arthritis include.

  • Advanced age
  • Degenerative disc disease
  • Previous history of trauma or injury
  • History of poor posture
  • Family history of degenerative arthritis

Facet Hypertrophy Prognosis

Facet joint hypertrophy (also known as chronic pain syndrome) is a painful, progressive disease. Patients should be aware that although there is no cure for the condition, treatments can help reduce the pain. In addition, to prevent further damage to the joints, leading an active lifestyle and maintaining a healthy weight is vital.

Facet Hypertrophy Diagnosis & Presentation

Chronic neck and back pain may be a common complaint. This pain may be worse after inactivity or in the morning. Rotation or extension of the spine may cause pain. Sometimes, the pain can be more severe. The pain may radiate to the buttocks, groin, and thighs.

The following during a physical exam will assist with diagnosis:

  • Kemp’s maneuver (The examiner helps the patient extend and rotate the spine to reproduce pain.
  • Rotation lateral
  • lateral bending
  • back extension

Imaging studies performed on patients, such as X Rays, CT scans, and MRIs, are recommended. Facet joint hypertrophy detects along with narrowing or calcification of the joint’s space. In addition, it is possible to find inflammation and cartilage breakdown. As well as bone spurs, hypertrophy of the Ligamentum Flavum, and an increase in subchondral bone volume, there may also be bone spurs. The ligamenta flavum is responsible for maintaining an upright posture. Disc injuries may occur when elasticity decreases with age.

Radiologic changes can also observe in patients who are not symptomatic. Therefore, further testing is required to confirm the diagnosis of facet hypertrophy. Medial branch blocks should also administer — ensuring the facet joints cause the pain.

Different Diagnosis

When diagnosing facet hypertrophy, it is essential to rule out any other causes of back and neck pain.

  • rheumatoid arthritis
  • osteophytes (bone spurs)
  • myofascial pain
  • Herniated discs
  • Compression fractures
  • Lumbar Radiculopathy
  • Osteoarthritis of Hip
  • sciatica
  • Impingement of the Sacroiliac Joint
  • Synovial and ganglion cysts
  • Ankylosing Spondylitis This type of arthritis can cause the vertebrae and joints to fuse, resulting in severe pain.
  • septic arthritis (this rare and infectious condition is more common in patients older than 60)
  • benign bone tumors
  • Cancer

Facet Hypertrophy Management


Although treatments do not cure facial hypertrophy, they can make the patient’s symptoms more manageable. These are some of the most common pain relievers:

  • Nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen are not available.
  • Relaxants such as metaxalone or cyclobenzaprine, like metaxalone, can be used to relax muscles.
  • Medial branch blocks

Non Pharmacotherapy

Regular massage and physical therapy can benefit patients with facet hypertrophy, strengthening the spine and core muscles. Radiofrequency ablation is a temporary treatment that uses heat to reduce the sensory nerve’s medial branch.

Local anesthesia is administered before the procedure — typically allowing for pain relief for 6-12 months. Some patients may feel pain relief for as long as two years. Pain relief may return once the nerves have regenerated. Additional treatments may be necessary if this happens. Although surgery to fuse the affected vertebrae is available, it is not always the first-line option and may not provide pain relief.

While complications after ablation are not typical, it is essential to follow up to ensure that there have been no adverse side effects.

What causes facet hypertrophy

Facet hypertrophy occurs by degeneration of the joints between the spine or spondylosis. Trauma, inflammatory disorders (such as ankylosing and rheumatoid spondylitis), and spondylolisthesis are other causes. In addition, the appearance of facet joint disease may cause thickening and new bone formation around the facet joints.

What is the treatment for facet hypertrophy?

The first-line treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and muscle relaxants.

What lifestyle changes reduce the severity?

A healthy lifestyle and weight can help prevent the degeneration of facet joints and reduce stress, reducing inflammation and pain. In addition, physical therapy, core strengthening exercises, and massage therapy can reduce the pain and inflammation in these patients.

The Deuk Spine Institute encourages and welcomes you to contact us today regarding any questions or concerns you may have about your current situation… 

​​If you or someone you love is experiencing any of the preceding symptoms outlined in this article, it’s time to get a FREE Consultation and MRI Review with the Deuk Spine Institute. We can help relieve your pain and get you back to living without limitations!

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