Surgery for Lumbar Facet Joint Disorders

Surgical treatment for facet joint pain is rare.¹Perolat R, Kastler A, Nicot B, et al. Facet joint syndrome: from diagnosis to interventional management. Insights Imaging. 2018;9(5):773–789. doi:10.1007/s13244-018-0638-x Typically, nonsurgical treatments are tried in various combinations for several weeks before surgery is considered.

When Surgery May be Recommended for Facet Joint Disorders

Surgery for signs and symptoms caused by facet joint problems may be advised in the following situations:

• Severely fractured or displaced facets that cannot be managed by nonsurgical methods²Mann SJ, Singh P. Lumbar Facet Arthropathy. [Updated 2019 Mar 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538228/
• Presence of concomitant conditions, such as symptomatic lumbar spinal stenosis (narrowing of the bony openings for spinal nerves), lumbar degenerative disc disease, or lumbar herniated discs²Mann SJ, Singh P. Lumbar Facet Arthropathy. [Updated 2019 Mar 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538228/^,3Su DCJ, Chang KV. Facet Arthritis. [Updated 2019 Mar 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://link.springer.com/article/10.1007/s13244-018-0638-x
• Spinal tumors or cysts⁴Alexander CE, Varacallo M. Lumbosacral Facet Syndrome. [Updated 2019 Mar 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441906/
• Cauda equina syndrome (compression of the spinal nerves that descend from the spinal cord)³Su DCJ, Chang KV. Facet Arthritis. [Updated 2019 Mar 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://link.springer.com/article/10.1007/s13244-018-0638-x

Unless there is a medical emergency, such as cauda equina syndrome, surgery is an elective procedure, which means it is the patient’s choice whether or not to have surgery.

See When Back Pain May Be a Medical Emergency

Surgical Techniques for Facet Joint Pain

Surgeries performed on the facet joints aim to reduce pain by improving the stability of the motion segment. A fusion of the adjacent vertebrae may be performed if a significant portion of the facet is removed. If a fusion surgery is done, the flexibility of the treated segment reduces considerably and usually does not return to normal.

Facet joint surgeries typically do not need open surgical techniques. Many procedures can be performed using a minimally invasive approach and/or endoscopically. These approaches use relatively small incisions and tend to cause minimal tissue damage. They also have a faster rate of recovery. It is not uncommon for more than one procedure to be performed during the same surgery.

Surgical procedures typically include:

• Lumbar decompression. A laminectomy surgery includes removal of the posterior part of the vertebra and may be done in facet disorders that lead to spondylolisthesis. In this condition, a vertebra slips over the vertebra below it, and may result in the compression of spinal nerves and/or the spinal cord.⁵Konan LM, Mesfin FB. Traumatic Lumbar Spondylolisthesis (Traumatic Lumbar Locked Facet Syndrome) [Updated 2019 Jun 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448159/ A laminectomy surgery restores space for these neural tissues and relieves compression.

  Watch Lumbar Laminectomy Surgery Video

• Reduction. A reduction surgery involves fixing of fractured facets and is usually performed in facet dislocation or fracture caused by high-energy trauma.⁶Konan LM, Mesfin FB. Traumatic Lumbar Spondylolisthesis (Traumatic Lumbar Locked Facet Syndrome) [Updated 2019 Jun 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448159/ Typically, other motion segment structures, such as the vertebrae and discs, are also affected in such type of trauma and are treated together.
• Facetectomy. A facetectomy involves trimming parts of a facet joint to remove excess bone (bone spurs) that may impinge on spinal nerves and/or the spinal cord.

Facet joint surgery may not always be successful.⁷Curtis L, Shah N, Padalia D. Facet Joint Disease. [Updated 2019 Jun 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541049/ Removal of a facet from a lumbar motion segment may cause gradual degeneration of the intervertebral disc as well as the other facet joints over time, leading to long-term problems.⁸Ozer AF, Suzer T, Sasani M, et al. Simple facet joint repair with dynamic pedicular system: Technical note and case series. J Craniovertebr Junction Spine. 2015;6(2):65–68. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426524/ While treating conditions such as spondylolisthesis, a spinal fusion surgery using lumbar instrumentation or spinal implants is usually necessary to stabilize the motion segment.

Read more about Lumbar Spinal Fusion Surgery

As with any surgery, there is always a small risk of serious complications, such as infection, excessive bleeding, nerve injury, and/or severe allergic reaction. Before deciding to have surgery for facet joint pain, it is important to discuss the risks and possible treatment alternatives with the surgeon.