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What is a Facetectomy?

By D. Jeffress
Updated Feb 26, 2024
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Facetectomy is an invasive surgical procedure that is performed to relieve pressure on spinal nerves. Nerve compression can cause significant radiating pain and loss of mobility, and surgery is often the only option to ease symptoms. The procedure involves exposing the affected vertebra and removing one or both facet joints that are rubbing against the nerve. When performed by experienced surgeons, facetectomy is a relatively low-risk surgery and most patients have excellent outcomes.

Each vertebra contains two facet joints that allow for spine mobility. They help a person bend forward, stand straight, and rotate left and right. Serious injuries to the spine and age-related degenerative disorders are the main causes of facet problems. If cartilage tissue around the joints erodes or tears, the bones may rub together and compress underlying nerves. The goal of facetectomy is to completely remove one or more facets in order to preserve nerve functioning.

A number of diagnostic tests and non-invasive treatments are administered before considering this procedure. X-rays are taken to look for misaligned facets and unusual bony protrusions. In order to determine the exact site of nerve damage, a specialist injects a fluorescent dye and a local anesthetic into the most painful area of the spine. If the anesthetic relieves the patient's pain, x-rays are taken to see exactly where the dye is situated. Facetectomy is needed if physical therapy, heat therapy, and pain relievers fail to improve the patient's condition.

In most cases, a patient is given a general anesthetic before the procedure. With the patient on his or her stomach, a small incision is made above the affected facet and skin, muscle, and ligament tissue is held aside with clamps. The surgeon then uses a bone saw or drill to carefully carve out the part of the facet that lies on top of compressed nerves. A deeper section of bone tissue called the lamina may also be removed. After confirming that the nerve is undamaged, the surgical wound can be sutured and dressed.

Patients usually need to stay in the hospital for several days following facetectomy so doctors can monitor recovery. X-rays are also taken to make sure the spine is stable. Specialists help a patient stand, bend, and walk lightly and ask if nerve pain still exists. Most people are instructed to get several weeks of bed rest before trying to return to physical activity. Follow-up sessions with physical therapists and spine doctors are important in the months after surgery to ensure a full recovery.

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Discussion Comments
By anon359830 — On Dec 21, 2013

@anon282990: I just had this procedure today. I'm having this done post a failed microdisectomy. I'm a 25 year old male and healthy besides this issue. The reason why they went with this procedure was remaining disc material pressing on the nerve roots. This, like the disectomy will help relieve nerve irritation.

In terms of post pain, it's not that bad. I can walk and it's manageable pain. Mind you, I'm post 15 hours surgery. Question your doctor as to why he's doing this procedure and get two or three different opinions and see what they recommend. It might be expensive, but it's your health. Best of luck, everyone.

By anon282990 — On Aug 01, 2012

I'm getting surgery on my back to remove a herniated disc and my doctor just gave me the information for the microdiscectomy, but now on my insurance claim they listed these: "laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar."

So now I'm reading up on what these all entail and how a microdiscectomy fits into this claim. Does anyone know if this list is standard on most insurance claims? These pages are very helpful for a 20 year old!

By lluviaporos — On Aug 23, 2011

@umbra21 - I think most people are apprehensive going into spinal surgery, even with facetectomies which aren't one of the more dangerous kinds, it's true.

But the nerves in the spine are extremely delicate, and surgery is always a risk, particularly in older patients.

I think you should just gently remind your friend of the pain she must be in at the moment, and of the fact that she will feel so much relief after the surgery. Living is dangerous, but not taking the risk is definitely the worse option in this case, in my opinion.

By umbra21 — On Aug 22, 2011

I have a friend who is going to have to have this kind of surgery and she is terrified. I am somewhat relieved having read this article that it doesn't seem to be considered any more dangerous than most kinds of surgery, actually, because to hear her speak she is in danger of every kind of complication you might imagine.

You can't blame her really, as back surgery always seems like a bit of a risk. But I've known other people to have surgery for a herniated disc and they were fine in the end. And this seems like it is even less dangerous than that.

I don't want to make her feel like her fears are trivial though, so I'll have to tread carefully.

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