Neck facet joints !

The cervical facet joints are pairs of small sliding joints at the back of the neck; they guide nodding, turning and side bending.

Official name: Zygapophysial (facet) joints

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What it is

Pairs of small sliding joints at the back of the neck, set at an angle that allows nodding, turning and side bending.

What it does

Guide and limit movement (lumbar facets block twisting), and share the load with the disc, especially when you lean back.

Key facts

Where: Between articular processes from C2–C3 to C7–T1 (zygapophysial joints)
Function: Synovial plane joints; facets about 45° to horizontal, allow flexion-extension, side bending and rotation; nerve: medial branches of dorsal rami (C2–C3: third occipital nerve)

Relations

In front: The intervertebral foramen with the exiting nerve root and its ganglion; further forward, the uncovertebral joint and the vertebral artery in the transverse foramina
Behind: Multifidus, semispinalis and the deep extensors; the medial branch of the dorsal ramus curves around the waist of the articular pillar
Medial: Lamina and ligamentum flavum, which blends with the front of the capsule; the spinal cord lies just inside
Lateral: Outer edge of the articular pillar (lateral mass), the landmark for lateral mass screws, with the vertebral artery in front

How to find it

With the person lying on their back and the neck relaxed, the articular pillars are felt as a firm column roughly two fingerbreadths to each side of the spinous processes, under the paraspinal muscles; tenderness over one level is sought when facet pain is suspected.

Examination

Extension-rotation (quadrant) test: the neck is extended and turned to one side; local neck pain without arm symptoms suggests a facet source, while pain spreading down the arm points to root compression in the foramen (Spurling sign)

On imaging

CT shows facet osteoarthritis (joint narrowing, osteophytes, subchondral sclerosis) and fractures of the articular processes. In dislocation, the lateral view shows perched or jumped facets and axial CT shows the empty 'naked facet'. Oblique views and CT show how much an enlarged facet narrows the foramen.

Common problems

Neck pain and headaches from arthritis or after whiplash.
Bone spurs that narrow the opening for a nerve root.

How it is diagnosed

There is no single sign. CT or MRI show arthritis; a numbing injection of the nerves to the joint (medial branch block) shows whether the joint is the pain source.

Treatment

Physical therapy, medicine, injections; radiofrequency ablation for lasting facet pain.

Clinical notes

Each joint from C3–C4 down is supplied by the medial branches of two levels; the waist of the articular pillar is the fluoroscopic target for medial branch blocks and radiofrequency neurotomy
The C2–C3 joint is supplied by the third occipital nerve; its pain is a classic cause of cervicogenic headache
Facet hypertrophy narrows the foramen from behind while uncovertebral spurs narrow it from in front, squeezing the root between them

Test yourself

Think of the answer, then tap the question to see it.

Which nerves supply the cervical facet joints?

The medial branches of the dorsal rami, two levels per joint from C3–C4 down; the C2–C3 joint is supplied by the third occipital nerve.

Pain from which cervical facet joint is a classic cause of cervicogenic headache?

The C2–C3 facet joint, supplied by the third occipital nerve; upper cervical facets refer pain to the head and suboccipital region.

On a lateral X-ray, how far is the vertebral body shifted forward in a unilateral versus a bilateral cervical facet dislocation?

About a quarter of its depth in a unilateral dislocation and about half in a bilateral one.

How do unilateral and bilateral cervical facet dislocations usually present neurologically?

Unilateral ones often present with a radiculopathy; bilateral ones more often with spinal cord injury.

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Educational information, not medical advice. For any symptom, see a health professional.

Its names

Official Latin (TA2): articulationes zygapophysiales TA2 1707
Official Spanish (DeCS): Articulación cigapofisaria DeCS D021801
English (TA2): Zygapophysial (facet) joints
Also called: facet joints · juncturae zygapophyseales · zygapophysial joints

Sources: Terminologia Anatomica (TA2); DeCS; Anatomy, Head and Neck: Cervical Spine.

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Representative model, for educational purposes only.

Neck facet joints highlighted on the Durgical 3D model