Facet joints — the small joints between adjacent vertebrae — develop arthritis with age. The pain is typically axial, worse with extension, twisting, or prolonged standing. Targeted facet injections and radiofrequency rhizotomy address it directly. Fusion is rarely the appropriate first answer.
Where the pain comes from
Each pair of vertebrae meets at two small posterior joints in addition to the disc in front. These facet joints have cartilage, a joint capsule, and a small synovial lining — just like other joints in the body. With age, mechanical loading, and sometimes genetics, the cartilage thins, the joint capsule thickens, and the joint becomes painful.The pain is typically described as a deep ache in the back or neck, worse with extension or twisting (which loads the facets) and relieved by flexion. It rarely radiates as nerve pain does — the symptom pattern is more diffuse than radicular pain.
How facet pain is confirmed
Imaging shows arthritic changes; the question is whether those changes are the source of the patient’s pain. Diagnostic medial branch blocks — temporarily anesthetizing the small nerves carrying signal from suspected facets — provide the test. If the pain goes away during the block, the joints implicated are the source.The block has both diagnostic and prognostic value. It identifies the source, and a positive response predicts likely success with radiofrequency rhizotomy.
Treatments that don't require fusion
For confirmed facet-mediated pain, the treatment ladder is well-established: physical therapy and conservative measures first, then targeted facet injections (corticosteroid plus local anesthetic), then radiofrequency rhizotomy for more durable relief. Each step has a defined purpose and decision point.Rhizotomy interrupts the small medial branch nerves carrying pain signal from the affected joints. The relief typically lasts many months as the nerves slowly regenerate, and the procedure can be repeated. Patients with predominantly facet-mediated pain can often manage their symptoms for years with periodic procedures rather than a single large operation.
Send your MRI for a free review
Dr. McMillan reviews each scan personally. You get a candid answer about candidacy before any travel or scheduling.
What we suggest doing first
If you are weighing this decision, the most useful single action is sending your MRI for a free review. The review costs nothing and produces a candid written assessment from Dr. McMillan — including the answer that you are not a candidate, when that is the honest answer. We do not ask patients to travel for a procedure that will not help them.
When the review indicates that the endoscopic approach fits, the next step is a $250 consultation. The fee covers Dr. McMillan’s time to review the imaging in detail and discuss what the procedure would involve for your specific situation. If you decide to proceed, the $250 is credited toward the procedure bundle. If you decide not to proceed, you owe the consultation fee and nothing further.
From there, scheduling moves at a pace that fits your situation. The procedure is outpatient, takes about an hour, and most patients are home the same day. Post-procedure follow-up is part of the bundle. For patients coming from out of town, the office coordinates lodging guidance, transportation considerations, and handoff with your local providers — this is a routine part of how we work, not an exception. The goal throughout is to make a complicated decision more navigable, with the actual numbers and the actual options in front of you.
When fusion enters the picture
Fusion for facet pain is reasonable in narrow circumstances: significant instability accompanying the arthritis, multi-level involvement that hasn’t responded to targeted treatments, or specific anatomical issues that change the calculus. Most facet pain doesn’t fit these criteria. A second-opinion review separates the cases where fusion is genuinely warranted from those where a targeted approach will serve better.Bottom line
Facet joints — the small joints between adjacent vertebrae — develop arthritis with age. The pain is typically axial, worse with extension, twisting, or prolonged standing. Targeted facet injections and radiofrequency rhizotomy address it directly. Fusion is rarely the appropriate first answer.
If you’ve been told you need a fusion — or you’re trying to avoid one — a free MRI review is the most useful next step. Dr. McMillan reviews each scan personally and tells you candidly whether the endoscopic approach fits your specific anatomy.
For patients dealing with spinal arthritis facet, the conversation comes down to specifics: what your imaging actually shows, what your symptoms are actually telling us, and which procedure (if any) genuinely matches that pattern. The candid answer is sometimes that you do not need surgery yet; the candid answer is sometimes that you do, but a smaller operation than the one you have been quoted. A second-opinion MRI review separates those cases and gives you the information you need to make the decision well.
The Synergy approach to spinal (facet) arthritis
Most patients arrive at Synergy Spine Center after being told their only surgical option is fusion. The practice was built on a different premise: when the imaging shows pathology that decompression can address, decompression is what’s recommended — not a fusion that locks the segment permanently. For spinal (facet) arthritis specifically, the typical pathway begins with a careful second read of your MRI, then a candid conversation about whether facet rhizotomy or facet joint injections would address the specific source of symptoms.
Dr. McMillan personally reviews every MRI submitted through the free MRI review portal. The review takes several business days and produces a written assessment of candidacy. If the imaging supports an endoscopic approach, you’ll receive a recommendation for the specific procedure and a transparent quote for the bundled price — surgeon, facility, and anesthesia all in one number. If the imaging shows something that wouldn’t benefit from endoscopic intervention, you’ll be told that directly, often with a referral to the appropriate specialty.
Recovery from endoscopic spine surgery for spinal (facet) arthritis is meaningfully faster than from open laminectomy or fusion. The incision is less than ⅓ inch, the procedure is outpatient under local anesthesia, and most patients are walking the same afternoon. Office workers typically return within one to two weeks; manual labor takes four to six weeks depending on the level of physical demand. The full pathway is documented at /how-it-works/ and the typical 3-day visit for out-of-town patients is at the 3-day plan. Authoritative background on this condition is also available at Cleveland Clinic — Facet Arthropathy.
Frequently asked
Is facet joint pain the same as arthritis?
Facet joints develop the same kind of arthritic changes as other joints in the body. The pain pattern is specific — axial, position-dependent — and the treatments are different from radicular nerve pain. To find out whether spinal (facet) arthritis is treatable through an endoscopic approach in your specific case, submit your imaging through the free MRI review — Dr. McMillan reviews each scan personally and provides a candid candidacy assessment.
Will an MRI show facet arthritis?
Yes, but MRI shows the anatomy, not the pain source. Imaging often shows facet changes that aren’t producing symptoms. Diagnostic medial branch blocks are the test for whether the joints are actually responsible. Transparent bundled pricing for the procedure is published openly at /spine-surgery-cost-transparent-pricing/, so you can plan financially before scheduling.
How long does rhizotomy relief last?
Many patients experience meaningful relief for several months to a year or more. The treated nerves regenerate, and the procedure can be repeated when symptoms return. To find out whether spinal (facet) arthritis is treatable through an endoscopic approach in your specific case, submit your imaging through the free MRI review — Dr. McMillan reviews each scan personally and provides a candid candidacy assessment.
Can facet injections cure the arthritis?
No — they reduce pain by quieting inflammation. The underlying arthritic changes continue. The combination of injections, rhizotomy, and lifestyle measures manages the symptoms. To find out whether spinal (facet) arthritis is treatable through an endoscopic approach in your specific case, submit your imaging through the free MRI review — Dr. McMillan reviews each scan personally and provides a candid candidacy assessment.
Should I have fusion for facet pain?
Usually not, unless there’s accompanying instability or other specific indications. Targeted treatments typically serve better for isolated facet-mediated pain. If you want the full procedural detail and what to expect during recovery, the facet rhizotomy page walks through technique, anesthesia, and the typical timeline.
What does it cost?
Diagnostic blocks and rhizotomy are typically covered by insurance for documented indications. The office can clarify coverage specifics. Patients who travel for care from out-of-town typically combine consultation and procedure into a single visit — the 3-day plan documents the standard cadence and what to plan for.
How this page was prepared
This page summarizes the clinical approach taken at Synergy Spine Center for the topic above. It is based on peer-reviewed literature, professional society guidelines (NASS, AAOS), federal patient education resources (NIH, AHRQ, CMS), and Dr. McMillan’s experience as Director of Spinal Medicine and Endoscopic Spinal Surgery. Outcome language is qualified. Individual results vary. Pricing where shown is current for 2026 and may change.
References
- PubMed — facet pain literature. — source
- NASS — facet pain resources. — source
- OrthoInfo — back pain. — source
- Cleveland Clinic — Facet Arthropathy — clinical reference on spinal (facet) arthritis.
- NIH NCBI — Lumbar Facet Arthropathy — clinical reference on spinal (facet) arthritis.
Synergy Spine Center publishes patient education content for general information only; it is not medical advice and does not establish a physician-patient relationship. For specific medical guidance, schedule a consultation. No identifiable patient information is included on this page.