Jeffrey R. Carlson, MD
You may think that being an Orthopaedist is all glamorous, like the movies or TV make it out to be. However, I did spend many years in school, working hard, learning how to be a good physician and surgeon. One of the most interesting subjects that I had to master was medical terminology, which is the language of the med/surg community. Take the word facetectomy and break it into its parts – “facet” + “ectomy”. Many of you are familiar with “ectomy”, as in tonsillectomy or lumpectomy, which means to remove or extract a tonsil or a lump. In this case, we’re removing a facet joint in the spine that has become arthritic, stiff and painful.
Now for an anatomy lesson. The spine is made up of 33 vertebral bones and consists of 31 spinal motion segments which include: two vertebrae and the spinal disc between them, two facet joints (that sit on the posterior side of the vertebra), and all the ligaments, nerves and other soft tissues. Facet joints are the only true joint in the spine and are quite small, but they play an important role in helping the spine bend and twist, while remaining stable. They work in conjunction with the cushiony spinal discs, which act as shock absorbers for the spinal column, sitting in between the vertebral bones. Because the discs have cartilage, they can also be considered arthritic when degenerative, even though they aren’t true joints.
When everything is healthy and functioning well, our spines are a marvel of creation. But when the facet joints, our spinal discs or both become compromised, pain and dysfunction are usually quick to follow. Because these two go hand-in-hand, it is often seen as a “chicken or the egg” relationship. Facet-joint arthritis often is diagnosed with degenerative disc disease and it may be difficult to tell what issue started first.
Facet joint arthritis causes the cartilage to wear away. As a result, the bones of the joint rub together and they often compress the spinal nerve roots that extend from the spinal cord out of the spinal column. This compression can be quite painful and can cause radiculopathy, the symptoms of numbness, tingling, pain and weakness in the limbs. It can also cause a loss of motion in the spinal segment affected. If the spinal disc at that level is also compromised and pressing on a nerve, the patient may be doubly affected with pain and dysfunction.
Facet joint arthritis is treated conservatively at first, with oral medications, Physical Therapy, activity modification, steroid injections and even radio frequency ablation of the nearby nerves to reduce pain. If these non-surgical methods fail, I will be consulted for surgical options.
If the facet-joint is the only problem, I can do a partial facetectomy, which removes up to half of the facet-joint. We don’t remove the whole facet joint as a stand-alone surgery, because it causes spinal instability. If there is disc degeneration involved, a bulging or herniated disc that is pressing on a nerve, I may also need to do a laminectomy or a microdiscectomy (remember our earlier medical terminology lesson?) to relieve pressure on the nerve. If there is instability, a spinal fusion may be the only answer. In that case, I can do a full facetectomy and not worry about spinal instability, because I will be using a cage, rods and screws to fuse the spine together anyway. The metal instrumentation I use is a sturdy scaffold for stability while the spinal vertebrae fuse together.
Although you don’t often hear the term facetectomy, it is one of the tools in my operating kit that I use frequently to help patients feel better when they suffer from spinal arthritis, disc degeneration or instability requiring spinal fusion surgery.