Spinal osteoarthritis is arthritis of the joints of the spine — chiefly the facet joints at the back of each segment, along with the bone spurs, ligament thickening and disc height loss that accompany them. Your report may call it spondylosis, facet arthropathy, degenerative joint disease or degenerative changes. These are describing the same process.
It is one of the most common findings in medicine, and one of the most commonly over-interpreted.
According to PubMed, a Framingham Heart Study analysis of community CT scans in adults aged 40 to 80 found facet joint osteoarthritis in 64.5 percent and intervertebral disc narrowing in 63.9 percent. The finding that matters most for reading your own report is this: when every degenerative feature was entered into a regression model together with age, sex and body mass index, only spinal stenosis was significantly associated with self-reported low back pain. The authors concluded that the other degenerative features appeared to be unassociated with it (Kalichman L, Kim DH, Li L, Guermazi A, Hunter DJ. Spine J. 2010;10(3):200-8. DOI).
That is a striking result and it is worth sitting with. Nearly two thirds of a community sample had arthritic facet joints, and having them did not predict whether a person had back pain.
The prevalence climbs steeply with age. According to PubMed, disc degeneration was present in 37 percent of asymptomatic 20-year-olds and 96 percent of asymptomatic 80-year-olds in a systematic review of imaging in people with no symptoms at all (Brinjikji W, et al. AJNR Am J Neuroradiol. 2015;36(4):811-6. DOI). By that age, a scan without degenerative change would be the unusual finding.
None of this means your pain is imaginary. It means the report has told you about your age and not about your pain, and that the work of finding out what actually hurts has not yet been done.
Age and cumulative load are the obvious drivers. The less obvious ones are where treatment leverage actually sits.
Body weight and metabolic health. In the same Framingham CT dataset, facet joint osteoarthritis was significantly more prevalent in the obese group, with an odds ratio of 2.8 (95% CI 1.1–7.2) (Kalichman L, Guermazi A, Li L, Hunter DJ. J Back Musculoskelet Rehabil. 2009;22(4):189-95. DOI). Mechanical load is only part of that story. Osteoarthritis is increasingly understood as having a metabolic and inflammatory component rather than being purely mechanical wear — which is why joints that bear little weight are also affected in metabolically unwell people.
Muscle. The same research group found that low density of the multifidus and erector spinae muscles was associated with facet joint osteoarthritis — odds ratios of 3.68 (95% CI 1.36–9.97) and 2.80 (95% CI 1.10–7.16) respectively — while paraspinal muscle density itself was not associated with the presence of low back pain (Kalichman L, Hodges P, Li L, Guermazi A, Hunter DJ. Eur Spine J. 2010;19(7):1136-44. DOI). Muscle quality and joint health travel together.
Glycation and inflammatory load. Chronically elevated glucose and insulin change the material properties of collagen and drive inflammatory signaling in joint tissue. This practice treats those directly rather than referring them out — see advanced glycation end products, pain and stiffness and medical weight management.
Prior injury and prior surgery. A fused or stiffened segment loads its neighbors differently, which accelerates arthritis at the levels above and below.
Where arthritis has progressed enough to crowd the nerves, the picture changes and adds a second layer: leg symptoms after a walking distance point to spinal stenosis, and one-sided limb pain along a single line points to foraminal narrowing.
The point of the evaluation is not to confirm that you have arthritis — your scan has already done that, and so has almost everyone else’s. It is to establish which structure is producing your pain.
Examination. What loads reproduce it, what positions relieve it, whether there is a neurological deficit, and how your hips and gait are contributing. Hip osteoarthritis presenting as back and buttock pain is a common and correctable misattribution — see hip pain that shows up in the groin, not the back.
Imaging read against symptoms. Useful for excluding fracture, tumor and infection, for assessing alignment, and for planning a procedure. Not useful for identifying which arthritic joint is the source, for the reasons set out above.
Diagnostic blocks, which are the actual test. A small volume of local anesthetic placed under image guidance onto a specific structure — the medial branches supplying a facet joint, a nerve root, the sacroiliac joint — either abolishes the pain temporarily or does not. In a spine full of arthritic joints, this is the only way to move from a list of candidates to an answer.
Exercise, which is the most consistently effective single intervention. Not as a consolation prize. Load-bearing joints depend on the muscle around them, and the association between paraspinal muscle quality and facet arthritis is measurable. Targeted strengthening, mobility and graded walking do work that no injection does.
Metabolic and inflammatory management. Weight, glycemic control, inflammatory load and sleep. Treated here as spine care rather than as somebody else’s department, because they operate on the process rather than on the symptom.
Image-guided injections targeted at a confirmed structure. Facet joint injections, medial branch blocks, epidural steroid injections where a nerve is involved, and sacroiliac joint injections. All performed under local anesthetic with no sedation — patients are awake, drive themselves home, and resume normal activity, including work, within two to four hours.
Radiofrequency ablation where blocks confirm the facet joints and relief is real but temporary. Repeatable, and nothing is removed or fused.
Medication, used with care. Worth knowing that some widely prescribed options perform less well than their prescribing volume suggests — the evidence for antidepressants in osteoarthritis and back pain is a good example, covered in this summary. In older patients, the medications used for arthritic pain interact with falls risk, kidney function and cognition, and the right answer is frequently to remove drugs rather than add them — see deprescribing and falls risk in older adults.
Where a peripheral joint is the real problem. Viscosupplementation and genicular radiofrequency ablation for the knee, and hip joint injection, are part of the same evaluation, because a painful hip or knee changes how a spine is loaded.
Surgery is not the treatment for spinal osteoarthritis itself. There is no operation that reverses arthritis in the joints of the spine, and there is no spinal equivalent of a knee replacement. Fusing segments to eliminate motion at arthritic joints is a large intervention that transfers load to the levels above and below.
That is a statement about this condition, not about this practice. Dr. Gurpreet Singh Padda, MD, MBA, MHP is a licensed physician and surgeon with surgical privileges, and this practice performs spinal surgery where it is indicated.
Surgery enters the conversation when arthritis has produced a consequence that an operation addresses: nerve compression causing a progressive deficit or intractable radicular pain, significant instability, or deformity affecting balance and function. In those cases the target is the compression, the instability or the alignment — not the arthritis. Where the arthritic joints themselves are the confirmed generator, the durable answer is a repeatable, non-destructive one plus sustained work on the drivers.
If you have been told you have arthritis in your spine and left with that as the whole explanation, there is more to find out. We see patients from across St. Louis, Clayton, St. Charles and the Illinois Metro East. Call (314) 481-5000 or request an evaluation.
Possibly, but the scan cannot establish it. Facet joint osteoarthritis was present in 64.5 percent of a community CT sample, and in that analysis it was not independently associated with reported low back pain once other factors were accounted for — only spinal stenosis was. Establishing which structure is producing your pain takes anesthetic blocks, not more imaging. Read more: Facet joint pain explained.
That framing is out of date and it is unhelpful, because it implies nothing can be done. Osteoarthritis has substantial metabolic and inflammatory components: facet joint arthritis was nearly three times as prevalent in the obese group in community CT data, and low paraspinal muscle density was strongly associated with it. Those are modifiable, and treating them is treating the disease process. Read more: Where arthritis pain actually comes from.
No — the opposite concern is better founded. Joint health tracks with the quality of the muscle around it, and disuse is independently harmful to both muscle and the inflammatory environment. What changes with arthritis is the choice and dosage of exercise, not whether you do it. Read more: Muscle, myokines and chronic pain.
It works on the mechanism in two ways at once — less mechanical load on load-bearing joints, and less inflammatory and metabolic drive on the tissue itself. Facet joint osteoarthritis carried an odds ratio of 2.8 in the obese group in community CT data. This is treated here as part of spine care rather than as advice offered on the way out. Read more: Visceral fat and metabolic inflammation.
That is the characteristic degenerative pattern: stiffness after rest that loosens with movement, then pain that accumulates through a day of loading. It is close to the reverse of inflammatory back pain, which is worse after rest and stays better with activity, and which points toward a different disease entirely. Read more: When autoimmunity is the source of pain.
Yes. Facet joints enlarge as they degenerate, and that enlargement can crowd the spinal canal or the exit where a nerve root leaves. Leg symptoms after a set walking distance suggest central narrowing; one-sided limb pain along one line suggests the exit. Both are separate, testable problems layered on top of the arthritis. Read more: Spinal stenosis and leg pain when walking.
Yes, and part of the answer is often subtraction rather than addition. Many drugs used for arthritic pain interact with falls risk, kidney function and cognition in older patients, and reviewing what you are already taking is a legitimate treatment step. Image-guided procedures that target a confirmed structure are frequently a lower-risk option than escalating systemic medication. Read more: Deprescribing and falls risk in older adults.
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