A facetectomy is a surgical procedure that removes or trims a portion of the facet joint in the spine. The goal is to relieve pressure on compressed spinal nerves, which cause pain, numbness, or weakness in the back and extremities. By removing a small part of the bony joint structure, surgeons create more space for nerve roots to exit the spinal column freely. This decompression procedure is used when conservative treatments, such as physical therapy or injections, fail to provide long-term relief from nerve impingement symptoms.
Understanding the Facet Joint and Pain Sources
Facet joints are small, paired joints located between the back parts of adjacent vertebrae throughout the spine. Also known as zygapophysial joints, they function with the intervertebral discs to stabilize the spine and limit excessive movement like rotation or over-extension. These joints are lined with cartilage and enclosed in a synovial capsule, allowing for smooth gliding motion.
Degenerative changes are the most common reason a facetectomy is needed, usually due to the wear and tear associated with aging, known as osteoarthritis or spondylosis. As cartilage deteriorates, the joints can enlarge or develop bony overgrowths, called bone spurs. This enlargement, or facet hypertrophy, narrows the space for spinal nerves to pass through, a condition called foraminal stenosis.
Compression of the nerve root causes pain that can radiate into the buttocks and legs, a symptom known as radiculopathy. This nerve impingement also leads to numbness, tingling, or muscle weakness in the affected limb. A facetectomy addresses this mechanical compression by removing the obstructing joint material.
How the Facetectomy Procedure is Performed
A facetectomy is often performed with other decompression surgeries, such as a laminectomy or foraminotomy, to ensure complete nerve freedom. The patient is positioned face-down, and the surgical area is confirmed using imaging guidance, such as X-ray fluoroscopy.
Surgeons use either a traditional open approach, which involves a larger incision to expose the spine, or a minimally invasive technique (MIS). MIS uses smaller incisions, often less than an inch, through which specialized instruments and tubular retractors are inserted. This method allows the surgeon to access the target area by gently spreading, rather than cutting, the surrounding muscles and soft tissues.
Once the joint is accessed, the surgeon uses micro-instruments to carefully trim or remove the hypertrophied portion of the facet bone. The most common form is a medial facetectomy, where only the inner part of the joint is removed to decompress the nerve root. If a significant portion of the joint is removed, the spine’s stability may be compromised, potentially necessitating a spinal fusion to stabilize the vertebral segment.
Recovery and Post-Operative Expectations
Following a facetectomy, patients are monitored in a recovery area while pain management transitions from intravenous to oral medication. Most people experience a hospital stay of one to two days, though minimally invasive procedures may allow for same-day discharge. Early movement is encouraged, and patients are assisted in walking short distances within 24 hours to help prevent complications like blood clots.
Patients must follow spinal precautions during the initial recovery period, which lasts between two and six weeks. These precautions include avoiding bending, twisting, and lifting anything heavier than 5 to 10 pounds. When getting out of bed, patients are taught to use the “log roll” technique to minimize spinal rotation.
Physical therapy usually begins a few weeks after the procedure to restore strength, flexibility, and proper posture. While the recovery timeline varies, most people return to light work and daily activities within several days to two weeks. Full recovery often occurs within four to six weeks. There is a small risk of complications, including infection, bleeding, or nerve injury, which the medical team monitors closely.