Spinal osteoarthritis is arthritis of the joints of the spine. Mostly that means the facet joints at the back of each segment. It also includes the bone spurs, thick ligaments and disc height loss that come with them. Your report may call it spondylosis, facet arthropathy, degenerative joint disease or degenerative changes. These all describe the same process.
It is one of the most common findings in medicine. It is also one of the most over-read.
According to PubMed, a Framingham Heart Study analysis looked at community CT scans in adults aged 40 to 80. It found facet joint arthritis in 64.5 percent and disc narrowing in 63.9 percent. The finding that matters most for reading your own report is this. Every wear feature was analyzed together with age, sex and body mass index. Then only spinal stenosis was significantly associated with self-reported low back pain. The authors concluded the other wear features seemed unlinked to 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 thinking about. Nearly two thirds of a community group had arthritic facet joints. Having them did not predict whether a person had back pain.
The rate climbs steeply with age. According to PubMed, a review of imaging in people with no symptoms at all found disc wear in 37 percent of 20-year-olds and 96 percent of 80-year-olds (Brinjikji W, et al. AJNR Am J Neuroradiol. 2015;36(4):811-6. DOI). By that age, a scan with no wear would be the unusual finding.
None of this means your pain is imaginary. It means the report told you about your age, not your pain. The work of finding out what really hurts has not been done yet.
Age and years of load are the obvious drivers. The less obvious ones are where treatment has real leverage.
Body weight and metabolic health. In the same Framingham CT data, facet joint arthritis was significantly more common 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). Load is only part of that story. Osteoarthritis is more and more seen as partly metabolic and inflammatory, not just mechanical wear. That is why joints that carry little weight also get it in metabolically unwell people.
Muscle. The same research group found that low-density (more fatty) multifidus and erector spinae muscles (the deep back muscles) were linked to facet joint arthritis. The odds ratios were 3.68 (95% CI 1.36–9.97) and 2.80 (95% CI 1.10–7.16). But back muscle density itself was not linked to having 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. Blood sugar and insulin that stay high change how collagen behaves. They also drive inflammation signals in joint tissue. This practice treats those directly instead of referring them out — see advanced glycation end products, pain and stiffness and medical weight management.
Prior injury and prior surgery. A fused or stiff segment loads its neighbors differently. That speeds up arthritis at the levels above and below.
When arthritis has grown enough to crowd the nerves, the picture changes and adds a second layer. Leg symptoms after a walking distance point to spinal stenosis. One-sided arm or leg pain along a single line points to foraminal narrowing.
The point of the evaluation is not to confirm you have arthritis. Your scan has already done that, and so has almost everyone else’s. The point is to find which structure is causing your pain.
Examination. What loads bring it on, what positions ease it, whether there is nerve loss, and how your hips and walking add to it. Hip arthritis showing up as back and buttock pain is a common mix-up that can be fixed — see hip pain that shows up in the groin, not the back.
Imaging read against symptoms. Useful for ruling out fracture, tumor and infection, for checking alignment, and for planning a procedure. Not useful for finding which arthritic joint is the source, for the reasons above.
Diagnostic blocks, which are the actual test. A small dose of numbing drug is placed under image guidance onto one specific structure. That could be the nerves to a facet joint, a nerve root, or the sacroiliac joint. Either the pain goes away for a while or it does not. In a spine full of arthritic joints, this is the only way to go from a list of suspects to an answer.
Exercise, which is the most consistently effective single intervention. Not as a consolation prize. Weight-bearing joints depend on the muscle around them. And the link between back muscle quality and facet arthritis can be measured. Targeted strength work, mobility and walking that builds over time do work that no injection does.
Metabolic and inflammatory management. Weight, blood sugar control, inflammation and sleep. We treat these as spine care, not as somebody else’s department, because they act on the disease process, not on the symptom.
Image-guided injections targeted at a confirmed structure. Facet joint injections, medial branch blocks, epidural steroid injections when a nerve is involved, and sacroiliac joint injections. All are done under local numbing with no sedation. Patients are awake, drive themselves home, and are back to normal activity, including work, within two to four hours.
Radiofrequency ablation when blocks confirm the facet joints and relief is real but short-lived. It can be repeated, and nothing is removed or fused.
Medication, used with care. Some widely prescribed options work less well than how often they are prescribed suggests. The evidence for antidepressants in osteoarthritis and back pain is a good example, covered in this summary. In older patients, drugs for arthritis pain affect fall risk, kidney function and thinking. The right answer is often to remove drugs, not 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. No operation reverses arthritis in the spine’s joints. There is no spine version of a knee replacement. Fusing segments to stop motion at arthritic joints is a big step. It shifts 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. This practice performs spine surgery when it is needed.
Surgery enters the talk when arthritis has caused a consequence that an operation can address. That could be a pinched nerve causing worsening nerve loss or nerve pain that will not quit. It could be major instability, or a deformity (a change in the spine’s shape) that hurts balance and function. Then the target is the pinch, the instability or the alignment — not the arthritis. When the arthritic joints themselves are the confirmed source, the lasting answer is one that can be repeated and destroys nothing. Add steady work on the drivers.
Maybe you were 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 us or request an evaluation.
Spinal arthritis lives in the small joints of the spine. An image-guided intra-articular injection of PRP injections or bone marrow concentrate delivers your own repair signals into those joints under X-ray. It treats the joint, paired with the strength and metabolic work in your plan. See all orthobiologic treatment options.
Maybe, but the scan cannot prove it. Facet joint arthritis was present in 64.5 percent of a community CT group. In that analysis, once other factors were counted, it was not tied to reported low back pain. Only spinal stenosis was. Finding which structure causes your pain takes numbing blocks, not more imaging. Read more: Facet joint pain explained.
That framing is out of date and unhelpful, because it implies nothing can be done. Osteoarthritis has large metabolic and inflammatory parts. In community CT data, facet joint arthritis was nearly three times as common in the obese group. Low-density (more fatty) back muscles were strongly linked to it too. Those can be changed. Treating them is treating the disease process. Read more: Where arthritis pain actually comes from.
No — the opposite worry is better founded. Joint health follows the quality of the muscle around it. Not using a joint harms both the muscle and the inflammation level on its own. What changes with arthritis is the choice and dose of exercise, not whether you do it. Read more: Muscle, myokines and chronic pain.
It works on the cause in two ways at once. It takes load off weight-bearing joints. And it cuts the inflammatory and metabolic push on the tissue itself. In community CT data, facet joint arthritis carried an odds ratio of 2.8 in the obese group. We treat this as part of spine care, not as advice offered on the way out. Read more: Visceral fat and metabolic inflammation.
That is the classic wear-and-tear pattern. Stiffness after rest loosens with movement. Then pain builds through a day of load. It is close to the reverse of inflammatory back pain. That kind is worse after rest, stays better with activity, and points to a different disease entirely. Read more: When autoimmunity is the source of pain.
Yes. Facet joints enlarge as they wear. That growth can crowd the spinal canal or the opening where a nerve root leaves. Leg symptoms after a set walking distance suggest central narrowing. One-sided arm or leg pain along one line suggests the exit. Both are separate problems on top of the arthritis, and both can be tested. Read more: Spinal stenosis and leg pain when walking.
Yes, and part of the answer is often taking away, not adding. Many drugs used for arthritis pain affect fall risk, kidney function and thinking in older patients. Reviewing what you already take is a real treatment step. Image-guided procedures aimed at a confirmed structure are often lower risk than more and more pills. Read more: Deprescribing and falls risk in older adults.
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