1. Facet Disease in the Neck – Conservative, Alternative & Surgical Treatments
Facet disease in the neck can understandably cause patients to feel anxious
and frustrated. Constantly enduring the spinal condition’s symptoms of pain,
stiffness, inflammation, and the sensation of bones rubbing against one
another can become tiresome, aggravating, and even depressing. If you are
dealing with the physical and emotional symptoms of facet disease in the
neck, take comfort in knowing that most patients are able to find relief from
noninvasive forms of treatment. Whether you decide to treat your condition
with traditional medicine or alternative therapies, the odds are in your favor
that you will eventually find relief without the need for surgery.
What is Facet Disease?
In order to completely understand how the various treatments for facet disease in the neck work, it may
be helpful for you to have a basic understanding of what the condition is and how it develops. Facet
disease is a type of arthritis that involves the gradual deterioration of the cartilage that lines the facet
joints, which connect articulating vertebrae in the neck and back.
As with other types of arthritis, facet disease typically occurs as a result of the natural aging process.
Years of supporting near constant movement in the neck and lower back can eventually take its toll,
causing the joints to gradually deteriorate. Most individuals first notice that their facet joints have
become arthritic when the neck begins to feel stiff after long periods of rest or first thing in the morning.
Stiffness is commonly accompanied by inflammation and soreness and symptoms may become more
severe as time goes on.
The body sometimes creates bone spurs (or osteophytes) in an effort to limit an affected joint’s
movement. These smooth nodules are harmless in and of themselves, but they can extend into the
spinal canal and compress the spinal cord or a nerve root. This can lead to neuralgia, which is pain,
tingling, and/or muscle weakness that extends along the length of a compressed spinal nerve. If facet
disease in the neck leads to bone spurs and neural compression, patients may experience neuralgia in
the neck, upper back, shoulders, and even the arms.
Treating the Condition with Conservative Techniques
Once your physician has determined that your neck pain is being caused by facet disease, he or she will
likely recommend a regimen of conservative, or noninvasive, treatments. Since no two patients are
alike, one treatment may benefit one patient but prove unsuccessful for another. As a result, finding the
most beneficial treatment or set of treatments may become a process of trial and error.
The treatment that most physicians primarily recommend is the use of nonsteroidal anti-inflammatory
drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen. NSAIDs can help to relieve the pain and
inflammation that are caused by facet disease in the neck by blocking the body’s production of the
COX-1 and/or COX-2 enzymes. If you suffer from a heart condition or have an illness that affects your
gastrointestinal tract, you may not be able to utilize NSAIDs. Be sure to tell your doctor if you suffer
from any other medical conditions and provide a complete list of medications that you are currently
taking. If your physician deems you a poor candidate for treatment with NSAIDs, he or she may
prescribe pain relievers or muscle relaxants.

2. Many patients who suffer from facet disease find that a combination of medication and physical therapy
provides sufficient relief. Working with a physical therapist can strengthen the muscles in the neck and
back, which may help to relieve some of the pressure that is being placed on a compressed spinal nerve.
Stronger muscles and ligaments can also assist the facet joints and other components of the spine with
their weight bearing responsibilities. Physical therapists may utilize other techniques in addition to
strength training, such as transcutaneous electrical nerve stimulation (TENS), posture modification
exercises, and hot/cold therapy, among others.
Your doctor may also recommend that you reverse certain habits that
could be exacerbating the symptoms of facet disease. Being
overweight, for instance, forces the facet joints to work extra hard to
support movement. Carefully modifying your diet and incorporating
low-impact exercises can help to alleviate neck and back pain while
also improving your overall health. Be sure to discuss any changes to
your diet or exercise routine with a doctor, as you may already be at a
healthy weight or could injure your spine even further by participating
in certain physical activities.
Alternative Therapies
Many patients claim to greatly benefit from alternative medicine that
takes a more holistic approach to the treatment of facet disease in the
neck. It is important to note that the medical community has yet to
reach a consensus regarding the efficacy of some of these treatments.
If you choose to pursue alternative therapies, either as the primary source of your treatment or in
conjunction with doctor-prescribed techniques, be sure to let your doctor know.
Some of the popular alternative therapies for chronic neck or back pain include:
• Acupuncture, which is the insertion of very small needles into specific points on the body. This
type of therapy is said to reduce pain by scrambling nerve signals and increasing the body’s
production of endorphins.
• Herbal supplements that are thought to reduce pain and inflammation. You should consult an
herbal nutritionist to find the vitamins and/or herbs that will provide you with optimal results.
• Yoga or Pilates, which are types of exercise that focus on strengthening the body’s core muscles
in the abdomen and back. Stronger muscles in these areas can allow the spine to exert less
effort when bending, twisting, and supporting body weight.
Surgical Treatment for Facet Disease
If you are among the small minority of patients who are unable to find relief after utilizing conservative
and/or alternative treatments for several weeks or months, your doctor or spine specialist may
recommend surgery. Before you consent to any operation, there are a few important questions you
should ask your doctor:
• Are there any other noninvasive treatments or combinations of treatments that haven’t yet
been utilized? Trying other treatments may prevent the need to undergo surgery. You may also

3. want to pursue a second opinion if your physician says there are no
other conservative treatments worth trying.
• Are you sure I’ve been properly diagnosed? Many spinal conditions can
cause similar symptoms, making it difficult for the correct diagnosis to
be formed. If your doctor diagnosed you with facet disease in the neck
without performing any diagnostic imaging (such as an X-ray, MRI, or
CT scan) you should request to receive one. While some doctors are
hesitant to expose patients to radiation or magnetic fields, medical
imaging can be particularly important for those who experience
debilitating symptoms. You may want to consult another physician for a
second opinion if your doctor is unwilling to perform any of these tests.
• Do I qualify for a minimally invasive procedure? Some patients are candidates for facet thermal
ablation procedures in lieu of open spine surgery. The procedure is much like an oral root canal,
in that the nerve ending that passes through the joint is deadened, thereby preventing pain.
These endoscopic procedures are performed on an outpatient basis and allow many patients to
return to their regular activities within a matter of weeks.
If your doctor recommends surgical treatment, don’t be shy about questioning his or her
recommendation. After all, you are ultimately in charge of your own health and should be 100 percent
comfortable with the risks and benefits of any procedure before you consent to undergoing surgery.