Cephalad and caudal vertebral facet joint prostheses and methods of use are provided. A pair of fixation elements are adapted to be secured within a vertebra in an orientation that best assures a secure and durable attachment to cortical and/or cancellous bone. Artificial facet joint surfaces are mounted on the fixation elements, either directly or with the aid of a support. The artificial facet joint structure may be carried by an arm. The artificial facet joint structure is adapted for articulation with a complementary natural or artificial facet joint structure. Bilateral prostheses may by coupled by a brace to further secure and stabilize the prostheses. Artificial facet joints can be used in combination with artificial intervertebral discs to treat a spinal pathology.