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facetectomy

Facetectomy

Conventional surgical approaches for lumbar foraminal stenosis or far lateral stenosis can be categorized as total facetectomy with/ without fusion and facet-preserving microforaminotomy. Total facetectomy offers sufficient decompression through the nerve root course. However, this often leads to segmental lumbar instability and back pain 1) 2) 3) 4).

Partial facetectomy

see Medial facetectomy.

see Complete facetectomy.

A facet-preserving microdecompression technique using a paraspinal approach was reported by Reulen et al in 1987 5) ,and Wiltse and Spencer in 1988 6).


Findings demonstrate that bilateral facetectomy (BF) during single-level TLIF improves clinical outcomes to a greater degree than unilateral facetectomy (UF) without any notable differences in perioperative complications or radiographic measurements 7).

Case series

1981

Seventy-eight patients who had been operated on for bony entrapment of lumbar nerve roots were studied in an attempt to define the clinical syndrome, and to assess the results of a new technique of decompression which preserves spinal stability. The mean age of the patients was 45 years and 28 of them had previously undergone spinal operations. Pain in the leg was the predominant symptom, with evidence of motor involvement in half of the patients. Signs of nerve root tension were found in only one-third of the patients. The principal factor in the aetiology was degenerative change in the posterior facet joints. Decompression was achieved by a partial undercutting facetectomy. Fifty-nine per cent of the patients obtained a “good” result and 85 per cent were satisfied with the result of their operation. Successful partial facetectomy for bony entrapment of lumbar nerve roots produced rapid and lasting relief of pain 8).

1) , 5)
Reulen HJ, Pfaundler S, Ebeling U. The lateral microsurgical approach to the “extracanalicular” lumbar disc herniation. I: a technical note. Acta Neurochir (Wien). 1987;84(1-2):64-67.
2)
Garrido E, Connaughton PN. Unilateral facetectomy approach for lateral lumbar disc herniation. J Neurosurg. 1991;74(5):754-756.
3)
JenisLG,AnHS.Spineupdate.Lumbarforaminalstenosis.Spine(PhilaPa1976). 2000;25(3):389-394.
4)
Epstein NE. Foraminal and far lateral lumbar disc herniations: surgical alternatives and outcome measures. Spinal Cord. 2002;40(10):491-500.
6)
Wiltse LL, Spencer CW. New uses and refinements of the paraspinal approach to the lumbar spine. Spine (Phila Pa 1976). 1988;13(6):696-706.
7)
Tye EY, Alentado VJ, Mroz TE, Orr RD, Steinmetz MP. Comparison of Clinical and Radiographic Outcomes in Patients Receiving Single-Level Transforaminal Lumbar Interbody Fusion With Removal of Unilateral or Bilateral Facet Joints. Spine (Phila Pa 1976). 2016 Sep;41(17):E1039-45. doi: 10.1097/BRS.0000000000001535. PubMed PMID: 26926356.
8)
Getty CJ, Johnson JR, Kirwan EO, Sullivan MF. Partial undercutting facetectomy for bony entrapment of the lumbar nerve root. J Bone Joint Surg Br. 1981;63-B(3):330-5. PubMed PMID: 7263743.
facetectomy.txt · Last modified: 2019/02/21 09:37 by administrador