Facet Joint Replacement

Description

There is a facet joint on the left and right sides of the posterior (back) region of the spine. These joints may undergo changes as the spine degenerates. This may result in the joints putting pressure on the nerve roots, causing pain. Traditionally, surgical treatment for this problem has been decompression with or without spinal fusion. One new treatment being evaluated in FDA-regulated trials is facet joint replacement. No facet joint replacement devices have been approved to date by the FDA.

Conditions Treated

Facet joint replacement is designed to treat lumbar stenosis.

Before the Procedure

Once you have decided to have surgery, the following events take place:

  • A medical examination.
  • Chest x-ray, EKG and blood work.
  • You may be asked to have a neurological or psychological examination.
  • If taking aspirin or anti-inflammatory medications daily, stop these medications at least one week before surgery.
  • If you take prescription medications or other drugs, including herbals, ask your doctor how soon before surgery you should stop taking these.
  • Do not have anything to eat or drink for 6 to 8 hours before surgery.
  • You will check into the hospital the morning of surgery.
  • Prior to surgery, you will be asked to sign permits for surgery, anesthesia, blood and blood products.

During the Procedure

  • An incision is made in the low back area.
  • Fluoroscopy, a method used to make images, is used to determine the correct level(s) to be operated.
  • The facet joints are removed, if needed, and decompression may be performed at the same time.
  • The devices are anchored to the vertebral bodies using metal screws or plugs.
    • For some devices, a bone cement is used to help hold the anchoring devices in place.
  • Surgery takes approximately 1-4 hours.

After the Procedure

  • You will be in the recovery room from 1 to 1½ hours.
  • The surgeon will contact your family while you are in recovery.
  • After going to a hospital room, you will be able to use a PCA pump to get medication for pain control. This machine controls the amount of medication that can be received.
  • Staff will usually get you out of bed the same day as the surgery.
  • The hospital stay is usually 1-3 days.
  • A brace or corset may be prescribed to restrict bending and promote healing of the operated area.
  • You will be given any needed prescriptions and discharge instructions.
  • A set of exercises that you can do at home will be provided.
  • You will be able to ride in a car or plane upon leaving the hospital.
  • Physical therapy is usually initiated after the first office visit with your doctor following surgery.

Recovery from facet joint replacement varies greatly among patients and is dependent on the extent of the surgery as well as the age and health of the individual. Return to work also varies greatly among patients and is related to overall health and the type of work you do.