Advanced age, damage to one or more vertebral discs, and other factors may play a part in the development of osteoarthritis in the spine.
While most people with osteoarthritis have at least one of the risk factors described below, it is possible to have no risk factors and still develop spinal osteoarthritis. The reverse is also true—it is possible to have all of these risk factors and never develop spinal osteoarthritis.
While not everyone will experience pain, nearly everyone has signs of spinal osteoarthritis by age the age of 50 or 60. 1 Eubanks JD, Lee MJ, Cassinelli E, Ahn NU. Does lumbar facet arthrosis precede disc degeneration? A postmortem study. Clinical Orthopaedics and Related Research 2007; 464:184-189. doi: 10.1097/BLO.0b013e3181583d4e As cited in Almeer G, Azzopardi C, Kho J, Gupta H, James SL, Botchu R. Anatomy and pathology of facet joint. J Orthop. 2020;22:109-117. Published 2020 Apr 8. doi:10.1016/j.jor.2020.03.058 , 2 Jarraya M, Guermazi A, Lorbergs AL, et al. A longitudinal study of disc height narrowing and facet joint osteoarthritis at the thoracic and lumbar spine, evaluated by computed tomography: the Framingham Study. Spine J. 2018;18(11):2065‐2073. doi:10.1016/j.spinee.2018.04.010 Older age is associated with:
- Degenerative changes in cartilage
- The cumulative effects of wear-and-tear on joints
- Excess inflammation that can occur throughout the body (systemic inflammation) as well as in the joints (localized inflammation) 3 Greene MA, Loeser RF. Aging-related inflammation in osteoarthritis. Osteoarthritis Cartilage. 2015;23(11):1966‐1971. doi:10.1016/j.joca.2015.01.008
All of these factors can contribute to the development of spinal osteoarthritis.
Degeneration of a vertebral disc
A vertebral disc serves as a cushion between two vertebrae. When a disc degenerates, it loses hydration and becomes smaller, leading to a reduction in space between the two adjoining vertebrae. This change can put excess pressure on the vertebrae’s facet joints, causing their cartilage to wear away, resulting in osteoarthritis. Osteoarthritis can also lead to disc degeneration, causing a vicious cycle.
Read more about Facet Joint Osteoarthritis on Spine-health.com
Like osteoarthritis, degenerative disc disease is most likely to occur in the neck and low back, because these are the areas of the spine that undergo the most motion and stress.
People who are obese are 5 times more likely to develop osteoarthritis in the lower back.
Facet joints are weight-bearing joints, and excess weight puts extra strain on these joints. In addition, obesity is associated with low-grade, systemic (body-wide) inflammation, which may contribute to the development of osteoarthritis. 5 King LK, March L, Anandacoomarasamy A. Obesity & osteoarthritis. Indian J Med Res. 2013;138(2):185‐193. PMCID: PMC3788203 , 6 Sartori-Cintra AR, Aikawa P, Cintra DE. Obesity versus osteoarthritis: beyond the mechanical overload. Einstein (Sao Paulo). 2014;12(3):374–379. doi:10.1590/s1679-45082014rb2912 , 7 Rosen CJ, "Pathogenic mechanisms of obesity-induced osteoarthritis: new clues from old joints." Osteoarthritis and Cartilage (2019), phone interview, June 10, 2019. doi:10.1016/j.joca.2019.02.007 (Obesity is defined as a BMI ≥ 30.)
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Scoliosis or poor alignment of the spine changes the biomechanics of the vertebra’s facet joints. During movement, these joints experience more stress and friction, increasing the risk of developing osteoarthritis of the spine.
Past injuries and trauma
A broken vertebra, serious back injury, or back surgery may cause joint damage that eventually leads to spinal osteoarthritis, although symptoms may not appear until many years later.
Chronic joint stress
When daily activities put a recurring strain on the neck or back, the facet joints can experience mini-traumas, increasing the risk of developing spinal osteoarthritis. For example, people who participate in high impact sports may be more prone to developing spinal osteoarthritis. 8 Curtis L, Shah N, Padalia D. Facet Joint Disease. [Updated 2020 Jan 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. Accessed August 6, 2020. https://www.ncbi.nlm.nih.gov/books/NBK541049/
Women are more likely than men to develop osteoarthritis in the lumbar spine. This difference is particularly noticeable after age 50. 9 Goode AP, Marshall SW, Renner JB, et al. Lumbar spine radiographic features and demographic, clinical, and radiographic knee, hip, and hand osteoarthritis. Arthritis Care Res (Hoboken). 2012;64(10):1536‐1544. doi: 10.1002/acr.21720 Evidence suggests that the drop in women’s estrogen levels during menopause may have a negative effect on the health of women’s facet joints. 10 Chen H, Zhu H, Zhang K, Chen K, Yang H. Estrogen deficiency accelerates lumbar facet joints arthritis. Sci Rep. 2017;7(1):1379. Published 2017 May 3. doi:10.1038/s41598-017-01427-7
Similar to height and hair color, the likelihood of a person developing spinal osteoarthritis may be influenced by genetics. 11 Kalichman, L., Li, L., Kim, D.H., Guermazi, A., Berkin, V., O’Donnell, C.J., Hoffmann, U., Cole, R., Hunter, D.J., 2008. Facet joint osteoarthritis and low back pain in the community-based population. Spine (Phila. Pa. 1976). 33, 2560–2565. doi: 10.1097/BRS.0b013e318184ef95 , 12 Bashkuev M, Reitmaier S, Schmidt H. Relationship between intervertebral disc and facet joint degeneration: A probabilistic finite element model study. J Biomech. 2020;102:109518. doi: 10.1016/j.jbiomech.2019.109518 (This is also true for other types of osteoarthritis, such as hand, knee, and hip osteoarthritis.)
Specific genes may increase the likelihood of cartilage breaking down at a younger age. Genes also influence joint structure, and an abnormal joint structure can increase the risk of osteoarthritis. 13 Poulet B. Models to define the stages of articular cartilage degradation in osteoarthritis development. Int J Exp Pathol. 2017;98(3):120‐126. doi:10.1111/iep.12230
Research regarding how risk factors influence the development of spine osteoarthritis is ongoing. A physician can diagnose the underlying cause of back pain.
Read more about Osteoarthritis Diagnosis