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Osteoarthritis of the spine: the facet joints

Abstract

Osteoarthritis (OA) of the spine involves the facet joints, which are located in the posterior aspect of the vertebral column and, in humans, are the only true synovial joints between adjacent spinal levels. Facet joint osteoarthritis (FJ OA) is widely prevalent in older adults, and is thought to be a common cause of back and neck pain. The prevalence of facet-mediated pain in clinical populations increases with increasing age, suggesting that FJ OA might have a particularly important role in older adults with spinal pain. Nevertheless, to date FJ OA has received far less study than other important OA phenotypes such as knee OA, and other features of spine pathoanatomy such as degenerative disc disease. This Review presents the current state of knowledge of FJ OA, including relevant anatomy, biomechanics, epidemiology, and clinical manifestations. We present the view that the modern concept of FJ OA is consonant with the concept of OA as a failure of the whole joint, and not simply of facet joint cartilage.

Key Points

  • Osteoarthritis of the spine involves the facet joints, the only true synovial joints between adjacent spinal levels in humans

  • The classic radiographic hallmarks of facet joint osteoarthritis (FJ OA) include narrowing of the facet joint space, subarticular bone erosions, subchondral cysts, osteophyte formation, and hypertrophy of the articular processes

  • FJ OA is widely prevalent in older adults, and is thought to be a common cause of back and neck pain

  • FJ OA may have a particularly important role in the ageing population with spinal pain

  • As with osteoarthritis of the extremities, FJ OA can be more accurately viewed as a failure of the whole-joint organ, and not simply of facet joint cartilage

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Figure 1: Facet joint and intervertebral disc anatomy.
Figure 2: Normal facet joints and advanced facet joint osteoarthritis.
Figure 3: Cervical and lumbar facet joint pain referral patterns.
Figure 4: Relationship between age and prevalence of low back pain attributed to lumbar facet joints.

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Acknowledgements

J. N. Katz's work is supported in part by a grant (P60 AR 47782) from the NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases.

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A. C. Gellhorn and P. Suri researched data for the article, and all authors provided a substantial contribution to discussions of the content, contributed to writing the article, and to review and/or editing of the manuscript before submission.

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Correspondence to Pradeep Suri.

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Gellhorn, A., Katz, J. & Suri, P. Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol 9, 216–224 (2013). https://doi.org/10.1038/nrrheum.2012.199

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