Facet arthrosis is classified according to the affected section of the spine and the severity of cartilage wear:

1. Cervical facet arthrosis: Affects the facet joints of the cervical spine, often causing neck pain and movement restrictions.
2. Thoracic facet arthrosis: Less common, affects the thoracic spine and leads to pain in the upper back.
3. Lumbar facet arthrosis: Most common form, affects the lumbar spine and causes lower back pain.
4. Grade I–IV: Classification according to the severity of cartilage damage, from minor changes to complete cartilage loss. 

The main causes of facet joint osteoarthritis are:

• Aging processes:
  • With increasing age, the cartilage in the facet joints loses elasticity and thickness, which promotes wear.
• Misloading:
  • Chronic poor posture, as occurs with desk work or unilateral loading, places uneven stress on the facet joints.
• Overweight:
  • Excessive body weight increases the pressure on the spine and accelerates the wear of the facet joints.
• Injuries:
  • Trauma or accidents can damage the facet joints and cause osteoarthritis in the long term.
• Degenerative diseases:
  • Disc damage or vertebral instabilities can increase the load on the facet joints.

The symptoms vary depending on the affected section of the spine and the severity of the osteoarthritis, but typically include:

• Localized pain:
  • Pain in the area of the affected spine, often in the lower back or neck.
• Movement restrictions:
  • Stiffness and pain during movements, especially when turning or bending the spine.
• Radiating pain:
  • Pain that radiates into the extremities, similar to a herniated disc.
• Muscle tension:
  • Reflexive spasms of the back muscles in response to the pain.
• Pain at rest:
  • Increased discomfort after prolonged sitting or lying down. 

The diagnosis is made through a combination of medical history, clinical examination, and imaging techniques:

- Medical history: The doctor inquires about the patient's medical history, the location of the pain, and possible triggers such as poor posture or injuries.

- Physical examination:

- Checking the mobility of the spine and targeted palpation of the affected areas.

- Imaging techniques:

- X-ray: Visualization of joint changes such as cartilage loss or bone growths.

- MRI: Detailed analysis of soft tissue damage and inflammatory processes.

- CT: Precise imaging of bony structures to assess joint changes.

Conservative Therapy Most facet arthroses can be treated without surgery:

• Physiotherapy:
  • Exercises to strengthen the back muscles and improve mobility.
  • Manual therapy to relieve tension.
• Pain management:
  • Taking painkillers such as paracetamol or ibuprofen.
  • Local application of heat or cold therapy for pain relief.
• Injections:
  • X-ray or ultrasound-guided cortisone injections to reduce inflammation and pain in the facet joints.
• Orthopedic aids:
  • Use of support corsets to relieve the spine.

Surgical Therapy Surgery is only considered for severe symptoms that do not respond to conservative measures:

• Facet denervation: Ablation of the nerve fibers that transmit pain signals from the facet joints.
• Stabilizing procedures: Surgical fixation of the affected spinal segments in cases of instability.
• Spinal fusion: Fusion of the affected joints for pain relief and stabilization.

To prevent facet arthrosis, the following measures are recommended:

1. Regular exercise: Promote back health through targeted strengthening and stretching exercises.
2. Ergonomic workplace design: Avoid poor posture through adapted office furniture and seating positions.
3. Weight reduction: Avoid overweight to reduce the load on the spine.
4. Avoid overloading: Limit heavy physical work or intense loads.
5. Early treatment of back pain: Immediate clarification in case of persistent complaints to prevent worsening.