How Is a Lumbar Facetectomy Performed?

A lumbar facetectomy is a surgical procedure to remove facet joints partially or completely in the lumbar vertebrae of the low back. Vertebrae are the chain of bones that form the backbone, which protects the spinal cord. The vertebrae are attached together by facet joints, which provide stability and flexibility to the backbone.

An orthopedic spine surgeon performs the lumbar facetectomy, typically with the patient under general anesthesia. A tube is inserted into the airway (endotracheal intubation) to assist breathing. The surgeon may administer regional or local anesthesia to numb the operative area, if the patient is unable or unwilling to undergo general anesthesia. The procedure may take approximately two hours.

Preparation

Prior to the surgery, the patient

• Undergoes blood and urine tests
• Undergoes imaging tests such as 3D CT scan, MRI and X-rays
• Is given antibiotics to prevent infection
• Must check with the surgeon before taking any regular medications
• Must inform the doctor of any allergies
• Must avoid eating and drinking for eight hours before the procedure

Procedure

The patient lies on a special table that allows X-rays to pass through, either flat on their stomach or over a frame that arches their back up, depending on the requirement.

The anesthesiologist

• Attaches an IV line for administration of anesthesia, medications and fluids.
• Performs endotracheal intubation and administers anesthesia through the IV line.
• Monitors the patient’s vital functions during the procedure.
• The patient’s nerve functions may be continuously monitored during the operation with techniques such as electromyography.

The surgeon

• Uses continuous X-ray (fluoroscopy) for guidance during the procedure.
• Makes a skin incision in the midline of the back or a little lateral to the midline, over the affected vertebra.
• Cuts through and retracts the tissue and muscle to expose the facet joint.
• Removes the ligament and cartilage around the joint.
• Cuts and removes the facet joint partially or entirely as required.
• May remove any herniated disc tissue or parts of bone compressing the nerve.
• May fuse the affected vertebrae together with bone graft, pedicle screws and a rod if the facet joints are removed entirely.
• Closes the incision with sutures.

Post-procedure

The patient is

• Weaned off anesthesia and administered painkillers.
• Monitored for a few hours in the recovery room.
• Discharged from the hospital in a day or two.

The patient may need to take a week or two off work. During the healing period, patients must avoid:

• Heavy lifting
• Standing or sitting for extended periods
• Strenuous activities

If the patient has degenerative disc disease, it is advisable,

• If a smoker, to give up smoking
• If overweight, to try to lose weight

To resume normal use of the back and limbs, the patient may require:

• A lower back corset for some period
• Follow-up checkups
• Physical therapy
• Occupational therapy

Complete recovery may take six to eight weeks, however, the patient may have to be cautious not to strain their back even after the recovery period. There may be some permanent limitations to certain movements, depending on the extent of joint degeneration and complexity of surgery.

Lumbar facetectomy is generally a safe procedure and most patients find relief from pinched nerve symptoms. As with any surgical procedure, lumbar facetectomy has certain risks including:

• Anesthetic side effects such as:
  • Headache
  • Nausea
  • Confusion
• Surgical risks such as:
  • Wound infection
  • Bleeding and hematoma
  • Blood clots
  • Injury to nerves, blood vessels or bone
  • Damage to the spinal cord membrane
  • Injuries from the positioning during surgery
• Complication that may arise include the following:
  • Persistent post-operative pain and complex regional pain syndrome
  • Spinal instability
  • Leakage of cerebrospinal fluid
  • Re-herniation of the disc or the residual fragment of facet joint
  • Long-term deformity if it is a multilevel procedure for removal of tumors in facet joints
  • Lack of symptom relief from the surgery