What Is a Lumbar Facetectomy?

A lumbar facetectomy is the removal of the facet joints from one or more vertebrae in the lower back.

A lumbar facetectomy is a surgical procedure to relieve the pressure on the nerve roots that pass close to the facet joints of the lumbar spine in the low back. During a lumbar facetectomy the surgeon partially or entirely removes the affected facet joints in the lumbar region of the spine.

The backbone is made up of a chain of bones (vertebrae) that form a protective covering over the spinal cord. Each vertebra has a main body separated from the adjacent ones by a sponge-like disc, which acts as a cushion.

Facet joints are two joints between each vertebra attached by cartilages and lubricated by a fluid known as synovial fluid. The facet joints are located on the bony projections called laminae, which extend on either side of the vertebral body to form an arch over it.

The lumbar facet joints provide stability and flexibility to the vertebral column of the low back. Facet joints allow gliding movements between the vertebrae that help a person stand up, bend or twist. Nerve roots emerge from the spinal cord through openings in the vertebrae, known as neural foramina.

A partial facetectomy is done to preserve as much of the facet joints as possible and may be accompanied by:

• Foraminotomy: removal of tissue blocking the foramina
• Laminotomy: partial removal of the lamina
• Laminectomy: complete removal of the lamina

A complete facetectomy is the removal of the entire facet joint on one or both sides of the vertebrae. A complete facetectomy is usually accompanied by a fusion of the two vertebrae with bone graft, a rod, and screws to prevent any movement between them and provide stability to the spine.

Medial facetectomy is the most-performed partial facetectomy. The procedure removes a part of the facet joint on the side close to the midline of the backbone.

A lumbar facetectomy is performed when medical treatments and physical therapy do not provide symptom relief from facet joint disease. When facet joints are damaged or degenerated, they compress the nerve roots and may cause:

• Pain in the back radiating to the legs
• Weakness in legs
• Numbness and tingling in the legs
• Difficulty in controlling certain muscles
• Loss of bowel and bladder control

A facetectomy is performed to release the compressed nerves and relieve the associated symptoms. Conditions that can require facetectomy include the following:

• Degenerative spine disease which leads to gradual loss of the normal spine structure due to:
  • Aging
  • Tumors
  • Infection
  • Arthritis
  • Traumatic injury to the spine
• Congenital conditions, such as kyphoscoliosis, that cause spinal misalignment
• Benign spinal tumors
• Inflammation or infections in the spine
• Narrowing of the neural foramen (foraminal stenosis) due to
• Degenerative disc disease
• Disc herniation
• Synovial cysts in the facet joints
• Bone spurs
• Abnormal connections between arteries and veins in the spine (arteriovenous malformation)
• A partial lumbar facetectomy is not performed in certain situations including:
• Absence of any sign of nerve compression in imaging studies 
• Skin or soft tissue infection at the surgery site
• Advanced age or other co-existing medical conditions that preclude a surgical procedure
• Presence of instability or deformity in the vertebrae that require a complete facetectomy and lumbar fusion