Facet joint arthritis
The facet joints are the small paired joints at the back of the spine that act like hinges. Like knees and hips, they have cartilage and can develop arthritis as they wear down. This is an extremely common part of aging — most people over 65 have some facet arthritis on imaging — and a common source of ongoing back or neck pain.
Symptoms
Aching pain centered in the midline of the back or neck, often worse leaning backward or twisting. It may spread into the buttock, hip, or thigh (or, in the neck, the shoulder) — usually without the sharp, shooting, down-the-leg pattern of a pinched nerve.
How it's diagnosed
There's no single perfect test. Imaging shows arthritis, but it's so common that it doesn't prove the facets are the source. The most reliable way to pinpoint it is a diagnostic nerve block — if numbing the facet's nerves relieves your pain, that joint is likely the culprit.
Treatment
Almost always managed without surgery: anti-inflammatory medicines, physical therapy, medial branch blocks, and radiofrequency ablation (heat that quiets the small pain nerves, giving longer-lasting relief). Surgery is rarely needed for facet arthritis alone.
Degenerative disc disease
Despite its alarming name, degenerative disc disease is not really a "disease" — it's the normal aging of the spinal discs. Over time, discs lose water, flatten, and become less springy, and small cracks can form. For many people this causes no problems at all; for some, it leads to back or neck pain and can set the stage for herniations and stenosis.
Symptoms
Low back or neck pain that comes and goes, often worse with sitting, bending, or lifting — sometimes spreading into the hips, buttocks, or thighs. If a worn disc leads to a herniation or stenosis, nerve symptoms can follow.
Causes
Aging is the main driver, but genetics play a large role (it runs in families), along with smoking, excess weight, a sedentary lifestyle, and heavy repetitive lifting.
Treatment
Non-surgical care is the mainstay for nearly everyone: exercise and physical therapy, medicines, weight management, quitting smoking, and good body mechanics. Surgery is reserved for when disc wear causes a specific, fixable problem — a pinched nerve (decompression) or an unstable, persistently painful segment (sometimes fusion or, in selected patients, artificial disc replacement). Surgery treats the consequences, not the aging itself.