Lumbar Foraminotomy / Facetectomy

Facet joints are present on either side of the vertebrae and connect one vertebra to the other. Similar to any other joint in the body, the articular surfaces of these joints are also lined by cartilage. Degenerative disc disease and osteoarthritis of the spine damage this cartilage causing the bones of the joint to rub against each other and results in formation of bone spurs in the facet joints. The neural foramen is the space present near the facet joints, on either side of the vertebrae, through which the spinal nerves leave the spinal canal. Bone spurs may protrude in the neural foramen and compress the nerve resulting in pain, numbness, tingling sensation and weakness in the legs.

Lumbar foraminotomy is recommended for the management of symptoms which fail to resolve by a conservative treatment approach. Lumbar foraminotomy is a surgical procedure that increases the space around the neural foramen and relieves compression of the spinal nerves by removing the disc fragments, overgrown ligaments and bone spurs from the neural foramen.  Sometimes lumbar foraminotomy is not sufficient to decompress the nerves and one or more complete facet joints are also removed, known as facetectomy. Removal of the facet joints destabilizes the spine, necessitating a spinal fusion following a facetectomy.

Procedure

Lumbar foraminotomy along with facetectomy is done under general anesthesia with the patient lying in a face down position, on the operating table. Guided by intra-operative fluoroscopy, a midline incision is made to the skin of the lower back over the affected neural foramen and the adjoining facet joint.  The back muscles are either cut or retracted to expose the lamina. A drill is used to completely remove the facet joint. Foraminotomy is then done to open the neural foramen. This involves the removal of a small segment of the lamina to reach the neural foramen. A surgical microscope is used to magnify the working area. Microsurgical instruments are used to remove the disc fragments and overgrown ligaments from the neural foramen. The spine is then stabilized by spinal fusion using spinal instrumentation and bone graft. After completion of the procedure, the muscles and soft tissues are placed in their normal positions and the incision is closed.

After the surgery

Patients are discharged from the hospital after three to four days of the surgery. Soon after the surgery, most patients experience a significant reduction in the leg pain. However the feeling of numbness, tingling and weakness in the legs improves gradually over a period of time. Pain at the incision site and the spasms of the back muscles are common but resolve within a week or two of the surgery.

Patients are advised to keep their incision completely dry.  Any activity involving lifting, bending or twisting should be avoided. With a few temporary restrictions most patients can resume work within two to four weeks of the surgery.

Risk

All surgical procedures are associated with some risk. Lumbar foraminotomy with facetectomy is a relatively safe procedure but the risks may include infection, bleeding, nerve damage and leakage of spinal fluid.