A Closer Look At Facet Cysts And Available Treatments

A facet cyst, though small—often no larger than a pea—may significantly affect a person’s quality of life if it presses against a nerve. In some cases, this cyst can cause severe discomfort or disability, while in others, it remains asymptomatic. 

Surgical interventions are commonly recommended for symptomatic cases, but understanding what facet cysts are, recognizing their symptoms, and exploring surgical and non-surgical treatment options can empower patients to make more informed decisions about their care.

What Is A Facet Joint?

The spinal column consists of vertebrae, the bones that form its structure. Intervertebral discs are between adjacent vertebrae, which act as cushioning pads to absorb shock. The vertebrae’s posterior (back) part features spinous processes—bony projections that can be felt when running fingers down the back. 

On either side of these spinous processes are small, finger-joint-sized articulations called facet joints, which connect one vertebra to the next. These joints play a critical role in spinal movement, compressing when bending backward and opening up when bending forward.

Facet joints are essential to the spine’s flexibility and stability. Understanding their function and how they relate to facet cysts provides a clearer picture of their role in spinal health.

Below is a medical illustration of the facet joints of the spine:

Facet joints play a dual role in the spine, enabling movement while limiting excessive motion to maintain stability. For example, cervical facet joints allow the neck to rotate up to 90 degrees in each direction but restrict further rotation to prevent injury. 

Like other joints in the body, facet joints are susceptible to wear and tear over time or damage from trauma, such as car accidents. These injuries can increase the risk for arthritis which can contribute to chronic pain and discomfort, especially during movement.

How A Cyst Affects A Facet Joint

When a facet joint becomes arthritic and swollen, it can produce a facet cyst—a fluid-filled expansion of the joint’s covering, known as the capsule. This swelling may occur in a specific area; in certain cases, the cyst can press on nerves within the spinal canal. 

This pressure can lead to pain in the spine or along the branch of the affected nerve. For instance, a cyst in the lumbar (lower) spine can cause pain radiating down the leg. Facet cysts most commonly occur in the lower back.

What Are The Causes Of A Facet Cyst?

Facet cysts are often associated with underlying conditions that compromise the health and stability of the spine. These small, fluid-filled sacs typically develop as a response to joint degeneration or structural imbalances, leading to irritation or overuse of the facet joints. Identifying the underlying causes of facet cyst formation can provide insight into potential management strategies. 

Common causes include:

• Osteoarthritis – The gradual breakdown of cartilage in the facet joints may result in inflammation and cyst formation.
• Degenerative Disc Disease – Loss of height or integrity in intervertebral discs can increase stress on facet joints, contributing to the development of cysts.
• Spinal Instability – Excessive movement between vertebrae may strain facet joints, triggering cyst formation as a protective response.

Symptoms Of Facet Joint Cysts

Facet joint cysts can cause various symptoms depending on their size and location. These symptoms often result from nerve compression and may vary in intensity. Recognizing these signs can aid in early identification of the condition and guide appropriate treatment.

• Radicular Pain: Sharp, shooting pain radiating from the back to the legs.
• Numbness or Tingling: Sensations of numbness, pins and needles, or localized discomfort in the lower back, hips, or legs caused by nerve irritation.
• Neurogenic Claudication: Leg pain or weakness triggered by walking or standing for extended periods.
• Bowel or Bladder Dysfunction: Rare but serious symptoms indicating significant nerve compression.

Methods For Diagnosing Facet Joint Cysts

Diagnosing a facet joint cyst typically involves a combination of symptom evaluation and advanced imaging techniques. Physicians use these methods to confirm a cyst’s presence, determine its size and location, and assess its impact on nearby structures, such as nerves. Standard diagnostic methods include:

• MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues, including facet joints and cysts, enabling identification of their size and effects on surrounding nerves.
• CT Scans: Offer cross-sectional spine images, providing a clear view of bone structures and joint changes related to cyst formation.
• X-rays: Help detect spinal alignment issues or degenerative changes that may contribute to facet cyst development.

Treatment Options Available

Facet cysts can be managed through various treatment approaches depending on symptom severity and their impact on daily life. Treatment options include:

• Cyst Aspiration Via Injection: A procedure where fluid is drawn out of the cyst using fluoroscopic guidance to reduce or eliminate the cyst. This approach is effective in approximately 70% of cases. However, 40% of patients may require repeat procedures, and 30% may eventually need surgery.
• Surgical Excision: Removal of the cyst through a laminectomy may impact stabilizing muscles. This option is typically considered when other treatments do not provide sufficient relief.

Address Facet Joint Cysts With Non-Surgical Approaches

Physicians in the licensed Regenexx network offer interventional orthobiologic procedures designed to help manage facet cysts while supporting spinal stability and function.

Rather than relying solely on surgery, which can alter joint mechanics and stability, targeted approaches such as cyst aspiration combined with image-guided injections of platelet-rich plasma (PRP) or bone marrow concentrate (BMC) may be considered. BMC, which contains a concentration of the patient’s own reparative cells and growth factors, is processed using Regenexx lab techniques to optimize joint environment support and promote natural tissue health.

These non-surgical strategies focus on addressing underlying contributors to cyst formation, such as joint degeneration and instability, rather than solely managing symptoms. Procedures using Regenexx injectates are designed to support the body’s natural repair processes, offering a personalized option for individuals seeking alternatives to invasive surgery.

While some cases may still require additional intervention, physicians in the licensed Regenexx network prioritize a proactive, less invasive approach. Exploring these options may help patients maintain mobility, manage discomfort, and support long-term spinal health without compromising joint integrity.

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