A facetectomy is a surgical procedure on the spine to remove one or both facet joints of a vertebra. Surgery aims to release pressure on a trapped nerve and reduce pain.
Facets are bony protrusions where vertebrae connect. The points at which they meet are called facet joints. These joint surfaces are covered with cartilage. A membrane called synovium surrounds the joint space and produces fluid to keep the spine lubricated.
The facet joints keep the spine in alignment as it moves. The spinal cord, running through the center of the vertebrae, may become damaged through injury or degenerative disease.
A facetectomy is one option to release pressure on the spinal cord or nearby spinal nerve roots to relieve pain or other symptoms.
This article will discuss the conditions treated by a facetectomy and what to expect before, during, and after the procedure. It will also outline what to expect from recovery and potential complications.
The spinal cord is a group of 31 pairs of nerve bundles that travel down the spine through the vertebrae.
Facet joints, along with intervertebral disks, provide smooth motion between vertebrae. However, they may be easily fractured in traumatic or sports injuries and frequently undergo age-related changes.
Facet joint degeneration can lead to pressure on the spinal cord or a nearby spinal nerve root, leading to pain in the back, which may radiate to other body parts. Those with this degeneration may also experience numbness, foot drop, weakened limb strength, and incontinence.
During a medial facetectomy, a surgeon removes a portion of one or both facets to create more space in the spinal canal and release pressure on the spinal nerves. They also remove part of the ligament that attaches the two vertebrae.
When the spinal cord becomes compressed, it is called spinal stenosis. There can be
- a herniated disk
- bone spurs
- spondylolisthesis, a condition where one of the vertebrae slips out of position
- disk degeneration due to osteoarthritis
- damage from rheumatoid arthritis
- spinal tumor
- fracture of the vertebrae
- Paget’s disease
- congenital stenosis
- scoliosis, which causes the spine to curve to one side
- achondroplasia or dwarfism
For degenerative spine conditions, many doctors will recommend nonsurgical back pain treatment before surgery. If that fails, they may discuss facetectomy. Doctors rarely recommend this surgery solely for degenerative conditions.
Surgery is a big decision. Health professionals can answer many questions and ensure a person feels prepared for surgery.
Before surgery
Before surgery, the doctor may ask for clearance from one or more other doctors, including family doctors or specialists. They will also provide instructions regarding any medications a person takes or any new ones prescribed for surgery. A doctor will discuss stopping smoking or limiting alcohol and how to plan for recovery at home.
After arrival at the surgery center or hospital, an anesthesiologist will ask a few questions and discuss their plans. It is important to tell them if anyone in the family has had difficulty with anesthesia.
During surgery
A typical facetectomy takes 1–2 hours. The surgeon will make a skin incision about 1–2 inches in length through the back near the affected facets and move muscles to expose the vertebrae.
They open the bony roof overlaying the vertebrae to reach the facet joints. They then remove the damaged portions of the affected facet joints. The surgeon repairs any other damage, like herniation of the disk, and performs spinal fusion if planned. Finally, they close the incision with sutures.
Depending on the circumstances, some surgeons may use smaller incisions with microinstruments, leading to faster recovery.
After surgery
A person may need 1–2 nights in the hospital to begin recovery. Some numbness, pain, or spasms in the affected leg may occur and should resolve with medication.
A person should arrange transportation home from the hospital.
A person must limit bending, lifting, and twisting for 4–6 weeks. Nurses will provide instructions on how to care for the spine while it heals. The doctor may or may not recommend wearing a brace.
People with jobs with little to no physical demand may return to work in 1–2 weeks. People with physically demanding jobs may need to stay off work for 6 weeks or longer.
The primary concern with a facetectomy is spine instability following surgery. Because a complete facetectomy, which removes a more significant portion of the facet joint, has a greater risk of instability, some surgeons may recommend following it with fusion of the vertebrae.
Other complications that may occur with any back surgery include:
- difficulty urinating
- problems with intestinal function
- heart attack
- stroke
- blood clots
- disk herniation
- nerve damage
- spinal headache
There is little research comparing the benefits of facetectomy and complication rates.
One
In one study mentioned in the review, of 78 people who underwent surgery,
A facetectomy is a surgery to remove portions of one or both facet joints of a vertebra to release pressure on the spinal cord or nearby spinal nerve roots. The facet joints are bony protrusions that align the vertebrae and are responsible for their smooth motion.
The spinal cord runs the length of the spine through the vertebra near the facet joints. Injury, trauma, or disease may cause the space between the cord and the facet joint to shrink, pinching the cord and causing pain in the back or elsewhere in the body.
During a facetectomy, the surgeon makes an incision along the back, gently moves nearby muscles, and exposes the spinal canal to visualize the area of nerve compression. They then access the facet joint to remove one or both and release pressure on the spinal nerve.
Typical surgery takes 1–2 hours and may require 1–2 days in the hospital. If a surgeon uses a minimally invasive approach with smaller incisions, healing may be faster. Recovery requires limited twisting, bending, and lifting for 2–6 weeks.