Should I Have Surgery for Back Pain From Facet Arthritis?

Typically unless there are unusual circumstances the answer is no. Of course there are exceptions such as if the patient has scoliosis or spinal instability.

When you have arthritis in multiple joints on both sides of the spine there really is no good answer with spine surgery. Arthritis usually affects multiple joints in the back and surgery would involve a spinal fusion of quite a few levels. It's very different than a hip or knee replacement, you only have 2 of those. With facet joints you have ten in the lumbar spine alone!

You could do a spinal fusion on multiple levels, but this will limit the person's mobility and cause other potential issues postoperatively such as infection, nerve injury, or worst of all - continued pain. The risk benefit profile for back surgery at numerous levels for facet arthritis is questionable, as a good facet joint replacement does not exist yet.

If the problem is focal and is occurring at one level of maybe two, then surgery may be a very good answer. But normal everyday wear and tear osteoarthritis at multiple spinal joints is not well served with a surgical procedure.

In effectively treating facet joint arthritis in symptomatic patients, the best method is non-operative procedures and other therapy options. These would include physical therapy, spinal decompression therapy, chiropractic treatment, and acupuncture, along with interventional pain management and potentially pain medications.

Nonsurgical treatment for facet arthritis can get typically well over 80% pain relief along with providing very little risk to the patient. The risks are small but real with interventional pain injections, however the benefit achieved can be dramatic and last for months to years.

The same benefit may be achieved with surgery, but the risks associated with this are also much more substantial than what the nonsurgical options entail. So surgery for facet disease really should be a last resort and care should be taken to make sure that there is a really good indication for surgery.