Total lumbar facet replacement: Indication, technique, and 3- and 4-year results

Abstract

Lumbar facet joint pathologies are a common cause of pain and motion restriction of the lumbar spine. In addition, hypertrophic facet deformities may contribute to spinal canal and foraminal stenosis, causing pain and/or neurogenic dysfunction such as motor and sensory defi cits as well as neurogenic claudication. In an aging population, facet degeneration is an increasing problem signifi cantly interfering with locomotion and mobility of seniors. The effects of conservative treatment are limited, especially if irreversible patho-anatomical alterations exceed the capabilities of compensatory mechanisms. In these cases, surgical treatment – sometimes restricted by major comorbidity in individuals of advanced age – may offer alleviation. Decompression of neural elements is the most important goal of surgery. Predominantly in elderly patients with notable comorbidity, only decompressive procedures such as hemilaminotomy, partial facetectomy, and foraminotomy are erformed uni- or bilaterally. In some cases, segmental stabilization by interspinous devices is added. In patients capable to tolerate more invasive surgeries and in those with major segmental instability, decompression is followed by posterior (PLIF), posterolateral (TLIF, XLIF), or even 360° fusion procedures [ 33 ].