Ces radiol. 2025, 79(4):261-267 | DOI: 10.55095/CesRadiol2025/030

Facet osteoarthritis from a radiologist's perspective - what to do about it?Review article

Radek Hlaváček¹, Jiří Jandura^{1, 2}, Milan Vajda¹, Radka Dvořáková¹, Michal Čech^{1, 2}, Vendelín Chovanec^{1, 2}, Jiří Vaňásek^{1, 2}, Petr Hoffmann^{1, 2}, Pavel Ryška^{1, 2}

¹ Radiologická klinika, Fakultní nemocnice Hradec Králové

² Univerzita Karlova, Lékařská Fakulta v Hradci Králové Korespondenční adresa:

Objective: This article aims to summarize current knowledge on facet (zygapophyseal) osteoarthritis as a frequently underestimated cause of chronic spinal pain. Attention is focused on pathophysiology, imaging diagnostics, and therapeutic options, particularly radiofrequency ablation (RFA), oxygen–ozone therapy (OOT), and the role of synovial cysts.

Methods: A narrative review of scientific literature published over the past two decades was conducted. The article outlines the anatomy and innervation of facet joints, their role in pain transmission, imaging findings on CT and MRI, and the use of functional modalities (SPECT/CT, PET/CT) in identifying active joints.

Results: Facet joints, together with the intervertebral disc, form the tri-joint complex, which ensures segmental spinal stability. Innervation via medial branches of the dorsal rami leads to overlapping pain zones and functional interconnection of adjacent segments. In the lumbar spine, facet osteoarthritis is a common pain source, often complicated by synovial cysts causing radiculopathy or neurogenic claudication. In the cervical spine, the C2–3 joint, innervated by the third occipital nerve, is a frequent source of cervicogenic pain. Morphological imaging (CT, MRI) is complemented by functional diagnostics (SPECT/CT, PET/CT), which assist in precise therapeutic targeting.

Conclusion: Facet osteoarthritis is a significant and often overlooked cause of chronic back and neck pain. Accurate diagnosis requires a combination of morphological and functional methods, confirmed by diagnostic blocks. RFA and OOT are effective treatment options, while the presence of facet cysts may warrant CT-guided aspiration or surgical decompression.

Keywords: facet joint osteoarthritis, spinal pain, diagnosis, radiofrequency ablation, oxygen-ozone therapy, cervical spine, thoracic spine, synovial cyst.

Accepted: October 1, 2025; Published: January 1, 2026  Show citation