Lumbar facet arthropathy (LFA) can be a painful degenerative condition affecting the facet joints in the lower back. These joints, which provide stability and facilitate movement in the spine, can undergo structural changes over time. While some degree of facet joint degeneration is common with aging, is the presence and severity of LFA an indicator of more advanced spinal degeneration or in isolation of itself?1
Understanding Lumbar Facet Arthropathy
Facet joints are synovial joints located between the vertebrae in the spine. They play a crucial role in stabilizing the spine and allowing controlled movement. Degenerative changes in these joints, known as facet arthropathy, can lead to pain and reduced mobility. These changes often include cartilage degradation, joint space narrowing, osteophyte formation, and subchondral sclerosis.2
The Progression of Facet Joint Degeneration
Research indicates that facet joint degeneration can progress through various stages, from mild cartilage wear to severe joint destruction. Facet arthropathy is present in 50 percent of the population by age 30 and 100 percent over age 60.3 A study involving 252 older adults found that severe facet joint osteoarthritis was associated with back pain, independent of other factors like disc degeneration . Additionally, a study examining the chronology of disc degeneration and facet joint arthritis revealed that facet joint arthritis could occur independently or concurrently with disc degeneration, suggesting that facet joint degeneration can be an early or concurrent event in spinal degeneration.4
Treatment Options
Early detection and management of facet joint degeneration are crucial for preventing further spinal deterioration and improving patient outcomes. Conventional treatment options for facet arthropathy treatments include:
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
- Physical Therapy
- Steroid Injections
- Radiofrequency Ablation (RFA) of the Medial Branch Nerve
- Acupuncture
Each of these options can be used alone or in combination depending on the severity of symptoms. However, these often only provide temporary relief as they are not addressing the loss of cartilage within the facet joint itself.
Treatments that Treat the Disease
Regenerative therapies, particularly platelet-rich plasma (PRP) injections, have shown great efficacy in treating lumbar facet arthropathy. Platelet-rich plasma (PRP) therapy repairs synovial joint arthropathy by modulating inflammation and promoting tissue regeneration. PRP is rich in growth factors and cytokines, exhibiting anti-inflammatory, anti-apoptotic, chemotactic, and proliferative properties that can facilitate tissue repair. In a controlled laboratory study, PRP treatment significantly reduced synovial fibrosis and cartilage degeneration in a rat model of knee osteoarthritis.5,6 Additionally, PRP has been shown to stimulate the proliferation of synovial fibroblasts and increase the production of hyaluronic acid, contributing to improved joint lubrication and function.
These findings suggest that PRP therapy may be a promising approach for managing synovial joint arthropathy by addressing both inflammatory and degenerative aspects of the disease.
A systematic review encompassing 13 randomized controlled trials and 27 non-randomized studies found that PRP was effective and safe for treating degenerative low back pain, with most studies reporting positive outcomes and minimal adverse events . Specifically, a prospective study involving 19 patients demonstrated significant pain reduction and functional improvement following intra-articular PRP injections into the lumbar facet joints, with 78.95% of patients reporting “good” or “excellent” outcomes at three months post-treatment.7
Additionally, a randomized controlled trial comparing PRP to corticosteroid injections in patients with lumbar facet joint disease found that both treatments improved clinical symptoms and MRI-detected synovitis. However, PRP injections led to a more pronounced improvement in MRI findings, suggesting a potential advantage in reducing joint inflammation.8
When the lumbar facet arthropathy is more severe, adipose derived stem cell therapy may be indicated. AD-MSC therapy improves cartilage integrity, subchondral bone remodeling, and alleviating spinal pain. AD-MSC therapy can modulate the inflammatory environment of the synovial facet joint and promote tissue regeneration.9 A recent long term study following 37 patients treated with AD-MSC into their lumbar facets demonstrated the long term benefits of the therapy.10
Conclusion
Lumbar facet arthropathy can be both a standalone degenerative condition or a component of a broader disease process, often co-occurring with other spinal degenerative changes such as disc degeneration or osteoarthritis. Understanding the progression of facet joint degeneration and its clinical implications is essential for effective management and treatment of patients with lumbar spine disorders.
Dr. Stacey Guggino, ND, LAc, graduated from the National College of Natural Medicine in Portland, Oregon with a Doctorate in Naturopathy and a master’s degree in Oriental Medicine. For the past 12 years, she has specialized in treating pain and sports injuries with acupuncture and prolotherapy. Dr. Guggino has also studied and practiced aesthetic medicine for 11 years.
Sources
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2. Liao S, Cheng L, Zhao Z, Zhu J, Huang F. Distinct characteristics and progression patterns of facet joint structural lesions in radiographic axial spondyloarthritis. Therapeutic Advances in Musculoskeletal Disease. 2024;16.
3. Eubanks D, Lee J et al. Prevalence of lumbar facet arthrosis and relationship to age, sex, and race: and anatomic study of cadaveric specimens. Spine 2007 Sep 1;32(19):2058-62.
4. Suri P, Hunter DJ, Rainville J, Guermazi A, Katz JN. Presence and extent of severe facet joint osteoarthritis are associated with back pain in older adults. Osteoarthritis Cartilage. 2013 Sep;21(9):1199-206.
5. Zhang JY, Xiang XN, Wang Q, Wang XX, Guan AJ, He CQ, Yu X, He HC. The Effect of Platelet-Rich Plasma on Synovial Fibrosis and Cartilage Degeneration in Knee Osteoarthritis. Am J Sports Med. 2025 Mar 20:3635465251324942.
6. Mariani E, Pulsatelli L, Cattini L, Dolzani P, Assirelli E, Cenacchi A, Di Martino A, Arciola CR, Filardo G. Pure Platelet and Leukocyte-Platelet-Rich Plasma for Regenerative Medicine in Orthopedics-Time- and Preparation-Dependent Release of Growth Factors and Effects on Synovial Fibroblasts: A Comparative Analysis. Int J Mol Sci. 2023 Jan 12;24(2):1512.
7. Wu J, Du Z, Lv Y, Zhang J, Xiong W, Wang R, Liu R, Zhang G, Liu Q. A New Technique for the Treatment of Lumbar Facet Joint Syndrome Using Intra-articular Injection with Autologous Platelet Rich Plasma. Pain Physician. 2016 Nov-Dec;19(8):617-625.
8. Kotb SY, Sherif NM, Saleh HA, Ahmed SF, Sakr HM, Taeimah MO. The role of intra-articular injection of autologous platelet-rich plasma versus corticosteroids in the treatment of synovitis in lumbar facet joint disease. Saudi Med J. 2022 Nov;43(11):1200-1208.
9. Zhao J, Sun Y, Sheng X, Xu J, Dai G, He R, Jin Y, Liu Z, Xie Y, Wu T, Cao Y, Hu J, Duan C. Hypoxia-treated adipose mesenchymal stem cell-derived exosomes attenuate lumbar facet joint osteoarthritis. Mol Med. 2023 Sep 5;29(1):120.
10. Rothoerl R, Tomelden J, Alt EU. Safety and Efficacy of Autologous Stem Cell Treatment for Facetogenic Chronic Back Pain. J Pers Med. 2023 Feb 28;13(3):436.
Image Credit: Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. – Own work, CC BY 3.0
