Which statement about the sources of vertebral pain is accurate?

• A. Facet joints can be a source, accounting for 15-40% of vertebral pain
• B. Only the intervertebral discs can cause pain
• C. Vertebral pain never comes from muscles
• D. Nerve roots are the sole source of vertebral pain

Answer: (A)

Pain in the spine comes from several structures, and facet joints are a well-known source of axial vertebral pain. The facet joints, or zygapophyseal joints, can become painful through degenerative changes, inflammation, or capsulitis, and they are innervated by the medial branches of the dorsal rami, so irritation here can produce deep, localized back or neck pain that can even refer to nearby areas. Clinically, facet-mediated pain is a substantial portion of vertebral pain, with estimates around 15–40%. That makes this statement the most accurate reflection of how vertebral pain can arise. Other sources like intervertebral discs, muscles, and nerve roots can also cause pain, but none are so exclusively implicated as the sole source; discs can cause pain, muscles can generate pain, and nerve roots produce radicular symptoms rather than pure axial vertebral pain.