Educational only — not medical advice. This page explains a published mechanism of a medical condition for general education. It is not a diagnosis, not a treatment plan, and not a substitute for evaluation by a qualified clinician.
Facet Arthropathy: What the Wear on Your Scan Looks Like in 3D
A 127-second narrated 3D animation of facet arthropathy, the wear in the small joints at the back of the spine that so often appears on MRI, CT and X-ray reports. It shows what wears, why the scan alone can't say whether a joint hurts, the two numbing tests that can, and what radiofrequency ablation does, with the full transcript and the references behind its claims.
Transcript
What the video says, beat by beat
-
Facet arthropathy on your MRI or X-ray
“Does your MRI or X-ray say facet arthropathy? It sounds like your spine is wearing out. It means wear in the small joints at the back of your spine, one of the most common findings on spine imaging.”[1,2]
-
Two small joints at every level
“Behind each disc sits a pair of small joints, the facet joints. They guide how you bend and twist. Like a knuckle, each has smooth cartilage and a capsule with pain-sensing nerves.”[2,3]
-
Wear, like a knuckle
“With time, the cartilage thins, the edges grow small spurs and the capsule thickens. On CT scans of the lower back, nearly 9 in 10 people in their 60s had it.”[1,2]
-
The scan shows wear, not pain
“In that study, people with these changes were no more likely to have back pain than people without them. A scan alone can't show which joint, if any, is causing your pain.”[1,4]
-
Pain that stays mostly local
“When a facet joint is the cause, the ache sits mostly in the neck or back, sometimes spreading to the shoulder blade or buttock. Leaning back or twisting often makes it worse, though that alone can't prove it's the joint.”[2,3,5,6]
-
Two numbing tests, 80% both times
“Pain like this often eases within weeks, with exercise. When it lasts for months, the small nerves to that joint are numbed twice, first with a short-acting anesthetic, then a longer-acting one. If your usual pain drops by 80% or more both times, for about as long as each lasts, that joint is a likely source.”[7,8,9,10,11,12,13,14]
-
Heat on the nerves, not the joint
“Radiofrequency ablation can then quiet those nerves with heat. In people who respond, relief usually lasts seven to nine months, and it can be repeated if it helped. Some large trials found little added benefit, and one guideline advises against it.”[15,16,17,18,19,20]
-
Signs it's more than joint pain
“Back or neck pain with fever, numbness between the legs, trouble controlling your bladder or bowels, new weakness, clumsy hands or unsteady walking needs care now. Call 911 or go to the nearest emergency room.”[21,22]
What the science says
References
According to PubMed: every journal reference below was verified against its live PubMed record on October 10 or 11, 2026, and the Medicare policy against its current version (effective April 9, 2026). Numeric findings from individual studies are attributed to those studies and are not promises of results. BodyParts3D models the vertebrae but not the joint capsules, cartilage, bone spurs or medial branch nerves, so those are drawn in the film from the anatomy described in references 2 and 3, placed where the atlas vertebrae meet. The film shows the lower back. The same joints, and the same two-block test, apply in the neck.
-
Kalichman L, Li L, Kim DH, Guermazi A, Berkin V, O'Donnell CJ, et al. Facet joint osteoarthritis and low back pain in the community-based population. Spine (Phila Pa 1976). 2008;33(23):2560-2565.
Covers: CT scans of 188 Framingham Heart Study participants. Moderate or more advanced facet joint wear (grade 2 or higher) was present in 24.0% of people under 40, 44.7% in their 40s, 74.2% in their 50s, 89.2% in their 60s and 69.2% over 70, and was most common at L4-L5 (45.1%). People with facet joint wear at any level were no more likely to report low back pain in the past year
-
Gellhorn AC, Katz JN, Suri P. Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol. 2013;9(4):216-224.
Covers: the facet joints as the only true synovial joints between neighbouring vertebrae, their anatomy and biomechanics (more load passes through them when the spine is extended), their nerve supply from the medial branches, lower-back facet pain referred mainly to the buttock and thigh, how enlarged joints can narrow the spaces for the nerves, and facet joint osteoarthritis as a failure of the whole joint rather than of the cartilage alone
-
Cohen SP, Raja SN. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology. 2007;106(3):591-614.
Covers: a review of lower-back facet joint pain, including the medial branch nerves that supply each joint and its capsule, the patterns of referred pain, how often the facet joints are the source (up to 15% of chronic low back pain in some estimates), and why no single finding on history or examination reliably identifies a painful facet joint
PubMed · PMID 17325518 · DOI · 10.1097/00000542-200703000-00024
-
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;21(9):1199-1206.
Covers: the counterpoint to reference 1. In 252 older adults from the Framingham Offspring cohort (a separate, older sample, mean age 67), severe facet joint wear on CT was linked to back pain (odds ratio 2.15), and each additional severely worn joint raised the odds further. Mild wear was close to universal by middle age, and a scan still cannot say which joint, if any, hurts
-
Fukui S, Ohseto K, Shiotani M, Ohno K, Karasawa H, Naganuma Y, et al. Referred pain distribution of the cervical zygapophyseal joints and cervical dorsal rami. Pain. 1996;68(1):79-83.
Covers: in 61 patients, each neck facet joint referred pain to a characteristic area. The upper joints referred to the back of the head and neck, the middle joints to the lower neck and the top of the shoulder, and the lowest joints to the shoulder blade
-
Cohen SP, Hurley RW, Christo PJ, Winkley J, Mohiuddin MM, Stojanovic MP. Clinical predictors of success and failure for lumbar facet radiofrequency denervation. Clin J Pain. 2007;23(1):45-52.
Covers: in 192 patients treated with radiofrequency ablation after positive blocks, pain on leaning back and twisting (facet loading) predicted failure, not success. Tenderness beside the spine was the only finding linked to a good result. The authors advise against using facet loading alone to choose patients
PubMed · PMID 17277644 · DOI · 10.1097/01.ajp.0000210941.04182.ea
-
da C Menezes Costa L, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ. 2012;184(11):E613-E624.
Covers: 33 cohorts (11,166 people). In new low back pain, average pain fell from 52 to 23 out of 100 by six weeks and to 6 by one year. Pain that had already persisted improved more slowly, from 51 to 23 at one year
-
Hush JM, Lin CC, Michaleff ZA, Verhagen A, Refshauge KM. Prognosis of acute idiopathic neck pain is poor: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2011;92(5):824-829.
Covers: new neck pain improved by about half in the first six weeks (64 to 35 out of 100), then levelled off, with an average of 42 at one year. Neck pain often levels off rather than settling completely
-
Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530.
Covers: for chronic low back pain, the guideline's first choice is non-drug treatment, including exercise, rehabilitation and several mind-body and manual therapies (strong recommendation), with medicines considered after an inadequate response
-
Barnsley L, Lord S, Bogduk N. Comparative local anaesthetic blocks in the diagnosis of cervical zygapophysial joint pain. Pain. 1993;55(1):99-106.
Covers: the two-block method in the film. In 47 people with neck pain after whiplash, the nerves were blocked double-blind with lidocaine or bupivacaine, and anyone who responded had the block repeated with the other anesthetic. Of 44 who had relief from both, 34 had longer relief from the longer-acting bupivacaine, a result very unlikely to be chance, and the authors concluded comparative blocks are a valid way to identify a painful facet joint
-
Manchikanti L, Boswell MV, Singh V, Pampati V, Damron KS, Beyer CD. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Musculoskelet Disord. 2004;5:15.
Covers: in 500 patients with chronic spine pain tested with comparative blocks, the facet joints were the source in 55% of neck pain and 31% of low back pain. A single lidocaine block was falsely positive in 63% of neck pain and 27% of low back pain, which is why a second, confirming block is used
-
Centers for Medicare & Medicaid Services. Local Coverage Determination: Facet Joint Interventions for Pain Management (L35936). Medicare Coverage Database.
Covers: the Medicare coverage policy that applies in New York. Before radiofrequency ablation it requires at least two diagnostic medial branch blocks, each giving at least 80% relief of the usual pain, with relief lasting about as long as the anesthetic used. Modal Pain uses this two-block, 80% standard for every patient, whatever the insurance plan
-
Cohen SP, Bhaskar A, Bhatia A, Buvanendran A, Deer T, Garg S, et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Reg Anesth Pain Med. 2020;45(6):424-467.
Covers: lower-back facet joint guidance from about a dozen pain societies. It recommends a single block, with at least 50% relief counted as positive, with the Spine Intervention Society dissenting in favor of two blocks at 80%. It notes that a single block is falsely positive in an estimated 17% to 41% of patients. Modal Pain uses the stricter two-block standard (reference 12)
-
Hurley RW, Adams MCB, Barad M, Bhaskar A, Bhatia A, Chadwick A, et al. Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group. Reg Anesth Pain Med. 2022;47(1):3-59.
Covers: the matching guidance for neck facet joint pain, including how medial branch blocks are done and read. Lidocaine typically lasts around two hours, and bupivacaine three to eight hours in some studies but not all
-
Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996;335(23):1721-1726.
Covers: the sham-controlled trial in 24 people with neck facet pain confirmed by placebo-controlled blocks. Pain took a median of 263 days to come halfway back after real treatment, against 8 days after sham. Five treated patients had numbness in the skin supplied by the treated nerves, and none found it troubling
-
Smuck M, Crisostomo RA, Trivedi K, Agrawal D. Success of initial and repeated medial branch neurotomy for zygapophysial joint pain: a systematic review. PM R. 2012;4(9):686-692.
Covers: 16 studies. After a first successful ablation, more than 50% relief lasted an average of 7.3 to 8.6 months in the neck and 9.0 months in the lower back, generally ending after 7 to 9 months. When the first ablation worked, a repeat worked 67% to 95% of the time in the neck and 33% to 85% in the lower back
-
MacVicar J, Borowczyk JM, MacVicar AM, Loughnan BM, Bogduk N. Lumbar medial branch radiofrequency neurotomy in New Zealand. Pain Med. 2013;14(5):639-645.
Covers: 106 patients chosen by complete relief on controlled blocks. In the two practices, 58% and 53% had complete relief for at least six months with a full return to normal activities. Relief lasted 15 months after a first treatment and 13 months after repeats
-
MacVicar J, Borowczyk JM, MacVicar AM, Loughnan BM, Bogduk N. Cervical medial branch radiofrequency neurotomy in New Zealand. Pain Med. 2012;13(5):647-654.
Covers: 104 patients with neck pain chosen by complete relief on controlled blocks. In the two practices, 74% and 61% had complete or at least 80% relief for six months or more. Relief lasted 17 to 20 months after a first treatment and 15 months after repeats
PubMed · PMID 22458772 · DOI · 10.1111/j.1526-4637.2012.01351.x
-
Juch JNS, Maas ET, Ostelo RWJG, Groeneweg JG, Kallewaard JW, Koes BW, et al. Effect of radiofrequency denervation on pain intensity among patients with chronic low back pain: the Mint randomized clinical trials. JAMA. 2017;318(1):68-81.
Covers: in the facet joint trial (251 people in the Netherlands, chosen with a positive diagnostic block), radiofrequency ablation added to a three-month exercise program did no better than the exercise program alone at three months. The difference was 0.18 points on a 0 to 10 scale, far below the 2 points set in advance as meaningful
-
Busse JW, Genevay S, Agarwal A, Standaert CJ, Carneiro K, Friedrich J, et al. Commonly used interventional procedures for non-cancer chronic spine pain: a clinical practice guideline. BMJ. 2025;388:e079970.
Covers: an international guideline panel made a strong recommendation against joint radiofrequency ablation, and against joint-targeted injections of local anesthetic or steroid, for axial (non-radiating) back or neck pain lasting three months or more. The panel called for more research, including on whether some kinds of spine pain respond differently
-
Finucane LM, Downie A, Mercer C, Greenhalgh SM, Boissonnault WG, Pool-Goudzwaard AL, et al. International framework for red flags for potential serious spinal pathologies. J Orthop Sports Phys Ther. 2020;50(7):350-372.
Covers: the international framework for warning signs of serious spinal problems such as cauda equina syndrome, spinal infection, fracture and cancer, including fever, numbness in the saddle area, bladder or bowel changes and new weakness. It notes that the evidence for most single red flags is limited, so they guide clinical reasoning rather than act as a checklist
-
Davies BM, Mowforth OD, Smith EK, Kotter MR. Degenerative cervical myelopathy. BMJ. 2018;360:k186.
Covers: compression of the spinal cord in the neck from wear-related changes. Typical signs are clumsy hands (trouble with buttons, keys or writing), numbness, unsteady walking and falls, sometimes with bladder problems. It is often mistaken for carpal tunnel syndrome or for getting older. Worsening symptoms need an urgent MRI and prompt specialist referral, because delayed treatment leads to poorer outcomes