Total lumbar facetectomy without fusion: short and long term follow-up in a single surgeon series

• Published in: British journal of neurosurgery Vol. 31; no. 5; pp. 531 - 537
• Main Authors: Pichelmann, Mark A., Atkinson, John L. D., Fode-Thomas, Nicolee C., Yaszemski, Michael J.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.10.2017; Taylor & Francis Ltd
• Subjects: Long term; Lumbar disc surgery; lumbar radiculopathy; lumbar spine surgery; Pain; Short term; spine surgery; Surgeons; total facetectomy; spine surgery; Lumbar disc surgery; lumbar spine surgery; lumbar radiculopathy; total facetectomy
• ISSN: 0268-8697; 1360-046X
• DOI: 10.1080/02688697.2017.1319905

Background: Total lumbar facetectomy may be advantageous for exposure or to completely free a constricted nerve root. Objective: We retrospectively reviewed a single surgeon series without fusion for short and long term outcomes regarding radicular pain relief, subsequent relevant surgeries, and any identifiable instability. Methods: All operations in which a single, total lumbar facetectomy was performed were reviewed. A total of 222 patients were identified with a minimal follow-up of 3 months; 187 (84.2%) were available for long term follow-up ≥1 year by continued accessible health care records, correspondence, or mailed questionnaire. Results: Short term success (3-month follow-up) for radicular pain relief in 222 patients found the following results: 176 patients (79.3%) had no pain or minimal pain, and 16 patients (7.2%) were improved, and thus resulting in 192 (86.5%) with no pain, or improved radicular pain. 30 patients (13.5%) were postoperative failures at 3 months. Long term follow-up ≥1 year was available for 187 patients (84.2%); (range 1-17 years; mean 7 years); found the following results: 23/30 (76.6%) short term surgical failures remained failures in long term follow-up with (7 patients) or without (16 patients) further surgery of any kind; 13/16 improved patients at long term follow-up remained improved (6), were pain free (6), or worse (1); 19/151 no or minimal pain patients at long term follow-up recurred or worsened by 1 year or longer, 12/19 pursued a second surgery with (9) or without (4) fusion and many improved. A total of 13 patients had a subsequent fusion operation (6.95%). Discussion: Most patients do well in the short term for radicular pain relief. Most patients continue to do well in long term follow-up. Surgically induced clinical instability is uncommon in this highly selected series.