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.
2. Facet Joint Injections 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.
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.
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.
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.
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).
Physical therapy to restore strength and mobility.
Pain management tailored to individual needs.
Regular follow-ups to monitor recovery and detect complications.