Spinal Arthritis Treatment Without Surgery

Facet arthropathy develops through a predictable cascade. Initial cartilage softening (chondromalacia) progresses to cartilage thinning, subchondral bone exposure, and compensatory bone remodeling. The body responds by forming osteophytes-bony spurs-along the joint margins, and the joint capsule thickens and inflames. The synovial membrane produces excess fluid and inflammatory cytokines. As the joint enlarges, it can encroach on the neural foramen, contributing to foraminal stenosis.

Interconnected degenerative cycle. What makes facet arthropathy particularly challenging is its relationship with disc degeneration. When a disc loses height, the facet joints behind it experience increased loading-they were designed for guiding motion, not bearing compressive weight. This increased load accelerates their degeneration. Conversely, facet joint stiffness and osteophyte formation alter spinal biomechanics in ways that accelerate disc degeneration at that level. The two processes feed each other in a degenerative cycle.

Dr. Crane's Regenerative Approach

Regenerative medicine offers a fundamentally different strategy: instead of blocking pain or burning nerves, we treat the joint itself.

Intra-articular regenerative therapy delivers concentrated growth factors directly into the facet joint, stimulating chondrocyte activity and extracellular matrix production, promoting healing of the joint capsule, and modulating the synovial inflammation driving pain. In my experience, patients with mild to moderate facet arthropathy respond well to a targeted series of regenerative treatments.

For more advanced arthropathy with significant cartilage loss, more potent regenerative approaches can provide mesenchymal stem cells capable of differentiating along the chondrocyte lineage, creating a stronger regenerative environment within the joint, supporting cartilage stability, and reducing the progressive bone remodeling that drives osteophyte formation.

Critically, I also address the disc degeneration that is driving increased facet loading. Treating the facet joint in isolation, while ignoring the degenerating disc that is overloading it, is like replacing brake pads while ignoring a bent axle. The comprehensive approach - addressing both the disc and the facet joint, stabilizing the ligamentous structures with regenerative treatment - produces more durable results because it addresses the entire degenerative segment.

What to Expect

Evaluation includes diagnostic medial branch blocks to confirm facet involvement, followed by MRI review to characterize the severity of arthropathy and any associated disc or ligamentous pathology. Treatment is delivered under fluoroscopic or ultrasound guidance for precise intra-articular placement.

We track both pain levels and functional outcomes-ability to stand, walk, and perform extension activities without flaring.

Frequently Asked Questions

Is spinal arthritis the same as osteoarthritis?

Yes. Facet arthropathy is osteoarthritis of the spine's posterior joints. The pathology is identical to osteoarthritis in the knee or hip-cartilage degeneration, osteophyte formation, synovial inflammation-just in a smaller joint. The regenerative principles that apply to knee arthritis apply here as well.

Can regenerative treatment replace radiofrequency ablation?

For many patients, yes. Regenerative treatment addresses the joint pathology directly, which RFA does not. However, in patients with severe arthropathy and refractory pain, we sometimes use a combination approach-regenerative treatment to address the biology and RFA for additional pain management while the regenerative process matures. The two are not mutually exclusive.

Will my arthritis continue to progress?

Spinal arthritis is a chronic degenerative condition. Regenerative treatment can slow the rate of progression, reduce inflammation, and improve cartilage health, but it does not eliminate the underlying susceptibility. Most patients benefit from periodic reassessment and maintenance treatments. The goal is to manage the condition effectively enough that it does not limit your function or quality of life.

How do I know if my pain is coming from the SI joint or my lower back?

Clinical differentiation can be challenging because SI joint pain and lumbar disc pain can produce similar referral patterns. The combination of provocative physical examination tests and a diagnostic SI joint injection provides reliable differentiation. If injection of local anesthetic into the SI joint relieves more than 75% of your pain, the SI joint is confirmed as the primary generator.

Is SI joint fusion ever necessary?

SI joint fusion is a surgical option for patients with refractory SI joint dysfunction who have failed all conservative measures. In my experience, many patients who are considering fusion have not been offered comprehensive ligamentous prolotherapy. I recommend exhausting regenerative options before considering fusion, as fusion is irreversible and carries its own risk profile. When fusion is genuinely necessary, I support that decision-but I want patients to have tried the less invasive option first.

Can pregnancy-related SI joint dysfunction be treated?

Yes. Postpartum SI joint dysfunction is common due to hormonal ligament laxity during pregnancy and the mechanical stress of delivery. Regenerative injection therapy is particularly well-suited for this population because it directly addresses the ligamentous laxity that is the root cause. Treatment can typically begin once breastfeeding has concluded and hormonal status has normalized.

Spinal Arthritis & Facet Arthropathy

Dr. Crane's Regenerative Approach

What to Expect

Frequently Asked Questions

Ready to Explore Your Options?

Spinal Arthritis & Facet Arthropathy

Dr. Crane's Regenerative Approach

What to Expect

Frequently Asked Questions

Degenerative Disc Disease

Spinal Stenosis

Chronic Spinal Sprains and Strains

Sacroiliac Joint Dysfunction

PRP Therapy

Prolotherapy

BMAC Therapy

Ready to Explore Your Options?