About 15-45% of the time
the facet joint is a cause of chronic low back pain [“]Perolat R, Kastler A, Nicot B, Pellat JM, Tahon F, Attye A, Heck O, Boubagra K, Grand S, Krainik A. Facet joint syndrome: from diagnosis to interventional management. Insights Imaging. 2018 Oct;9(5):773-789. doi: 10.1007/s13244-018-0638-x. Epub 2018 Aug 8. PMID: 30090998; PMCID: PMC6206372. Manchikanti L, Manchikanti KN, Cash KA, Singh V, Giordano J. Age-related prevalence of facet-joint involvement in chronic neck and low back pain. Pain Physician. 2008 Jan;11(1):67-75. PMID: 18196171.

Natural wear and tear of the facet joints can cause painful friction that can worsen into stenosis

1

Healthy spine

No canal arthrosis, facet capsule with synovial fluid allowing smooth facet joint and spinal motion

2

Facet syndrome

Little fluid left in the facet capsule, the resulting
friction causes inflammation and back pain

3

Lumbar Spinal Stenosis

The body naturally responds to this motion/instability by developing bone spurs. Nerve roots are compressed causing additional leg pain and a significantly reduced walking distance. The canal is often narrowed due to arthrosis

Cortisone
injections

Cortisone injections to reduce facet joint inflammation

Radio Frequency
Ablation

Temporary thermal
destruction of pain nerves
in the facets

Surgical
fixation

Surgical implantation
of medical devices blocking the facet motion causing pain (pedicle screws, facet fixation systems)

Treatment options vary in duration
of pain relief and invasiveness

Decompression
alone

Leg pain is relieved with decompression (bone removal) of canal / foramen. Back pain coming from dura-mater
compression is relieved.

If there is back pain coming from the facet joints, it is not addressed by the decompression alone technique.

Decompression alone may also cause postoperative instability and pain over time, potentially requiring a reoperation

Pedicle Screws
+ Decompression

Facet joint back pain and post decompression instability are addressed by adding pedicle screws to the decompression.

Pedicle screw fixation is often required for gross preoperative instability and/or deformity.

The rigidity of the pedicle screw construct may cause levels adjacent to the fixation to degenerate over time, potentially requiring a reoperation.

Facet fixation
+ Decompression

Facet joint back pain and post decompression instability are addressed by adding a facet fixation system to the decompression.

Facet fixation systems can be used in selected patients with up to moderate preoperative instability without deformity.

For these selected patient cases, facet fixation systems can be an alternative to pedicle screws. In two clinical studies comparing a facet fixation system to a pedicle screw construct in selected stenosis patients, facet fixation patients experienced shorter surgeries, less blood loss during the surgery and less adjacent level degeneration.

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