====== Lumbar facet joint degeneration surgical treatment ======

1. [[Lumbar Facet Joint Denervation]] (Radiofrequency Ablation - RFA):

Indication: Chronic pain localized to the facet joint, confirmed by diagnostic medial branch nerve blocks.

Procedure: Thermal ablation of medial branch nerves innervating the facet joints to interrupt pain signals.

Advantages: Minimally invasive, outpatient procedure, minimal recovery time.

Limitations: Temporary relief, lasting about 6-12 months in most cases.
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2. [[Facet Joint Injection]]s with Steroids:

Indication: Pain relief and inflammation reduction in degenerative facet joints.

Procedure: Steroid and anesthetic are injected directly into the joint space.

Consideration: Typically diagnostic or adjunctive, rather than definitive surgical treatment.
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3. [[Posterior Lumbar Fusion]] (PLF):

Indication: Severe facet joint degeneration causing instability, chronic pain, or radiculopathy.

Procedure: Fusion of the vertebrae to eliminate movement and reduce pain.

Techniques:

[[Posterior Lumbar Interbody Fusion]] (PLIF)

[[Transforaminal Lumbar Interbody Fusion]] (TLIF)

[[Lateral Lumbar Interbody Fusion]] (LLIF)

Advantages: Stabilizes the spine and addresses instability.

Limitations: Invasive, with potential for adjacent segment disease over time.
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4. Total Facet Joint Replacement (Facet Arthroplasty):
Indication: Advanced facet joint degeneration without severe instability or deformity.
Procedure: Replacement of the degenerated joint with an artificial implant to preserve motion.
Advantages: Motion preservation compared to fusion.
Limitations: Limited availability and patient selection criteria; long-term outcomes still being evaluated.
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5. Laminectomy with Facetectomy:
Indication: Significant facet degeneration contributing to central or foraminal stenosis.
Procedure: Decompression of the spinal canal and neural foramen by removing part or all of the facet joint.
Advantages: Alleviates nerve compression and associated symptoms.
Consideration: May require fusion if extensive instability is anticipated post-surgery.
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6. Spinal Stabilization with Dynamic Systems:
Indication: Patients needing stabilization without rigid fusion.
Procedure: Dynamic stabilization systems (e.g., pedicle-based devices) to allow controlled motion and reduce facet load.
Advantages: Reduces stress on adjacent segments and preserves some mobility.
Limitations: Emerging technology with varying outcomes.
Patient Selection Criteria:
Persistent pain refractory to conservative treatment (physical therapy, medications, injections).
Imaging evidence of facet joint degeneration (e.g., CT, MRI).
Exclusion of other pain sources (e.g., discogenic pain, radiculopathy).
===== Postoperative Considerations: =====

Physical therapy to restore strength and mobility.

Pain management tailored to individual needs.

Regular follow-ups to monitor recovery and detect complications.