What is a Facetectomy?
The facet joints are the joints in your spine from where the nerves exit your spinal cord through on their way to other parts of your body. These joints make your back flexible and enable you to bend and twist. Healthy facet joints have cartilage, which allows your vertebrae to move smoothly against each other without friction.
The facet joints, over the time, are prone to particularly wear and tear to degenerative disease, especially if there is trauma at some point in your life. So generally, facet joints do undergo arthritic changes, which happen with almost everyone with aging. This does not necessitate the occurrence of pain. Conservative treatments include physiotherapy, non-steroidal anti-inflammatories, exercise therapy, chiropractic or osteopathic manipulations, and spinal injections. These treatments can be very helpful in many cases; however, there may be times when these measures fail to control the pain. Facetectomy is only performed when these measures fail.
When is Facetectomy Indicated?
Lumbar facetectomy may be performed partially or completely. It may also be performed unilaterally or after a traumatic injury to the spine bilaterally, depending upon the pathology and mechanism at hand. The following conditions may indicate facetectomy.
- Degenerative spine disease
- A fracture and/or subluxation requiring open reduction and fixation
- Some congenital conditions such as kyphoscoliosis or other states of malalignment
- Neoplasms of the spine, in particular ones involving nerve roots such as schwannoma or neurofibroma
- Vascular lesions of the spine extending along a nerve root sleeve such as a spinal arteriovenous malformation
- Inflammatory conditions or infections of the spine leading to spinal destruction, misalignment, and requiring surgical reduction and fixation
A facetectomy procedure can relieve symptoms such as:
- Back and neck pain
- Decreased Radiating pain to the shoulder, arm, and buttock
- Mobility and flexibility
Preparing for Your Facetectomy
You will be provided preparation instructions before your facetectomy. You may be asked to do the following to prepare for facetectomy surgery (consult your physician):
Patients are asked to stop taking certain supplements and medications before Facetectomy. Some supplements and medications can increase the risk of bleeding. The doctor tells you which medications need to be stopped.
You will be asked to stop smoking as it has shown to slow down the recovery and contribute to back pain. For these reasons, you may be asked to stop smoking for some period of time before and after your facetectomy.
You will be asked to fast for 6 to 12 hours – You will be told exactly how many hours you will need to stop eating drinking before your facetectomy surgery.
How is Facetectomy Done?
This minimally invasive facetectomy procedure is performed through a small incision measuring approximately 1 inch with utmost care taken not to damage the surrounding tissue. This is done under fluoroscopic guidance. The fluoroscope gives real-time images of the spine during the procedure, enabling the accurate removal of the portion of the facet joint/bone spur which is putting pressure on the nerves.
Once the damage has been repaired, the patient is moved to the recovery room and monitored. Most patients are discharged to home the same day following facetectomy procedure.
Recovery Period Following Facetectomy
The recovery period depends upon the type of facetectomy you have gone through. For minimally invasive facetectomy the recovery period is about 4 to 6 weeks. Your doctor will tell you when you can return to your activities of daily living. Post surgical pain is managed by pain medications. You may be prescribed physical therapy.
Before you decide that traditional open back surgery is your best option, you should consider the safer, effective alternatives provided by your doctor. Facetectomy has its own risks and complications as discussed above. It is up to you to do the research for yourself, but the fact remains that some people have found significant relief from this procedure, and gotten their life back.