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.