Arthritis of the spine is the same process that stiffens knees and fingers, just in a more complicated location. The small facet joints at the back of each vertebra wear down with age, grow bone spurs, and lose their smooth motion. It is nearly universal after a certain age, and it is usually a minor problem.

The catch is the neighborhood. A stiff arthritic knee is just a stiff knee. Arthritic joints in the spine sit millimeters from your spinal cord and nerve roots. When bone spurs grow inward and joints enlarge, they can narrow the spaces nerves travel through. That is when arthritis stops being background wear and becomes something worth treating.

This is not the same as degenerative disc disease, though the two almost always show up together. Degenerative disc disease is the discs drying out and collapsing. Arthritis is the joints and bone spurs. They feed each other: a collapsing disc loads the facet joints harder, and arthritic, unstable joints load the discs harder. Patients often get both diagnoses on the same MRI report. The distinction matters because they cause different kinds of pain and they respond to different treatments.

Symptoms

Facet arthritis causes axial pain: a deep ache in the neck or back, worse with extension (arching backward) and after rest, often easing once you get moving. Morning stiffness is typical. Pressing on the sore area reproduces it. This is joint pain, the same flavor as an arthritic finger, located in the spine.

When bone spurs narrow the nerve tunnels (foraminal stenosis), the symptoms change. Pain, numbness, or weakness travels into the arm or leg along the path of the pinched nerve, sometimes with the electric, burning quality of nerve pain. Bone spurs in the center of the canal cause the walking-and-standing heaviness of spinal stenosis: legs that tire and go numb with activity, better with sitting.

Arthritis also causes stiffness between episodes. A spine that was once flexible gets rigid, and the rigid segments above and below work harder, which is how the process spreads.

How it is diagnosed

Diagnosis starts with the pattern. Pain that is worse with extension and better with flexion points at the facets. Pain that radiates into a limb points at nerve compression. The exam tests strength, reflexes, and sensation to look for a neurologic pattern.

X-ray shows the classic arthritic signs: narrowed facet joint spaces, bone spurs (osteophytes), and thickened bone. MRI shows whether those spurs are actually touching nerves and whether the discs are collapsing too. CT scan shows bone detail better than MRI and is useful when planning surgery around heavy spurring.

An honest point about imaging: arthritic spurs on a scan do not prove they are causing your pain. Plenty of people have impressively spurred spines and no symptoms. The exam and the symptom pattern have to match the pictures, or the pictures are just pictures.

Diagnostic injections can settle the question. A facet joint injection that numbs the suspected joint and relieves the pain for a few hours confirms the facet as the pain generator. That matters because it separates joint pain from nerve pain, which get different treatments.

Nonoperative treatment comes first

Arthritis is a wear process, not a break, so the first line is management, not repair. Physical therapy (core strengthening, flexibility, posture) supports the arthritic segments and keeps the rest of the spine moving. Anti-inflammatory medications calm the joint inflammation. Activity modification means avoiding the positions that load the worst joints, usually heavy extension.

Injection therapy has a real role here. Facet joint injections and medial branch blocks both treat and diagnose facet pain. Epidural injections calm nerve pain from spur-related stenosis. Injections do not fix the arthritis, but they can break a pain cycle long enough for therapy to work.

Most arthritic flares settle over weeks with consistent care. The arthritis itself does not reverse, but the pain around it is often manageable for long stretches.

When surgery is considered

Here is the line to draw carefully. Surgery for arthritic back pain alone, without nerve compression or instability, is a poor bet. Fusing a painful arthritic joint sometimes helps, but the results are less predictable than surgery for a pinched nerve, and the arthritis simply moves to the neighboring levels. A good surgeon will tell you when your arthritis is the kind surgery helps and when it is not.

Surgery is on the table when the arthritis is causing a structural problem surgery can fix: nerve compression from bone spurs with persistent radiating pain or progressive weakness, spinal stenosis that limits walking despite good nonoperative care, or instability where arthritic wear has let a vertebra shift.

Surgical options

Surgery does not cure arthritis. It treats what the arthritis is doing to the nerves or the alignment. When bone spurs are pinching a nerve, decompression removes the spur and opens the tunnel. When arthritic wear has made a segment unstable or collapsed, fusion stops the painful motion and holds the alignment while the nerves are freed. Sometimes both are needed in the same operation. The full details, candidacy criteria, and recovery timelines are on each treatment page.

Red flags: seek urgent care

Go to the ER or call your surgeon immediately if you develop:

New loss of bowel or bladder control, or numbness in the saddle area (inner thighs, groin, buttocks), which can signal cauda equina syndrome, a surgical emergency
Rapidly worsening weakness in an arm or leg, or new foot drop
Clumsy hands or new balance problems in the neck, which can signal cord compression from spurs
Severe neck or back pain after trauma, or pain with fever, which needs prompt evaluation for fracture or infection

FAQs

Is spinal arthritis the same as degenerative disc disease? They are different parts of the same wear process. Degenerative disc disease is the discs drying out and collapsing. Arthritis is the facet joints wearing down and growing bone spurs. They usually coexist and worsen each other, but they cause different pain: disc collapse tends toward instability and nerve tunnel narrowing, arthritis toward joint pain and spur-related pinching. Your surgeon sorts out which one is driving your symptoms.

My MRI says "multilevel spondylosis." Do I need surgery? Probably not based on the report alone. Spondylosis is the radiologist's word for age-related spinal arthritis, and it is a normal finding in middle-aged and older adults. Surgery is for a structural problem that matches your symptoms: a spur pinching a nerve, stenosis limiting your function, or instability. The report describes anatomy. Your symptoms and exam determine treatment.

Can the bone spurs be shaved off without a fusion? Yes, when the spur is the whole problem. If a bone spur is pinching a nerve in an otherwise stable segment, decompression removes the spur and leaves the spine's motion intact. Fusion enters when the segment is unstable, collapsing, or so arthritic that removing the spur would destabilize it. The flexion and extension X-rays are what decide.

Will arthritis come back after surgery? The arthritis at the operated level is addressed, but arthritis is a spine-wide process. Neighboring levels continue to age, and a fused segment loads them slightly more. That is one reason surgeons are conservative about fusing for pure arthritic pain: the underlying process continues either way.

Do I need to stop being active? No, with guidance. Motion is good for arthritic joints. Low-impact activity, core strengthening, and flexibility work are the mainstays. What to limit is heavy axial loading and repetitive extension through the worst segments. A PT who understands spinal arthritis is worth more than a generic exercise sheet.

Considering care in Naples

Arthritic changes on imaging are normal. Pain that limits your life is not, and the difference between the two is a clinical judgment, not a radiology report. If neck or back pain, or pain radiating into an arm or leg, is keeping you from the life you want, bring your imaging and your questions to HSS at NCH in Naples.

This page is educational and not medical advice for your specific condition.