What is Facet Joint Fusion?
The facet joints are the tiny joints situated at the upper and lower part of each vertebra, connecting one vertebra to the other. Each vertebra has four facet joints: a pair that connects to the vertebra above (superior facets) and another pair that connects to the vertebra below (inferior facets). They guide motion and provide stability.
Facet joint fusion is a surgical procedure aimed at relieving chronic back or neck pain caused by degenerative changes, arthritis, or instability in the facet joints. The procedure involves permanently joining (fusing) the bones around a facet joint to stop painful motion and stabilize that segment of the spine.
Indications for Facet Joint Fusion
Face joint fusion is usually considered when the facet joints degenerate or wear out over time due to ageing or arthritis, resulting in significant pain and restricted range of motion.
Your surgeon may typically recommend facet joint fusion surgery when:
- Pain is severe and interferes with daily life
- There is evidence of joint instability, severe arthritis, or spondylolisthesis
- Conservative treatments (e.g., physical therapy, injections, medications) have failed
- There has been a previous failed back surgery
The goal of the surgery is to:
- Eliminate painful motion at the facet joint
- Provide long-term stability to the affected spinal segment
- Alleviate nerve irritation if the instability is compressing nearby nerves
Procedure for Facet Joint Fusion
During a facet joint fusion, the goal is to permanently join (fuse) the bones around a facet joint to stop painful motion and stabilize that segment of the spine. In general, the procedure involves the following steps:
- You will be placed under general anesthesia (fully asleep).
- The surgeon positions you on the operating table usually in a prone (face-down) position.
- Fluoroscopy (live X-ray) or intraoperative CT navigation is used for precise guidance.
- A small incision is made over the affected area of the spine.
- Muscles and soft tissue are carefully moved aside to access the facet joints.
- The surgeon removes the cartilage within the facet joint.
- This exposes raw bone surfaces that are essential for fusion to take place.
- Any damaged bone or tissue may also be removed to prepare the area.
- A bone graft (taken from your pelvis, a donor, or synthetic material) is packed into or around the facet joint space. This acts as a bridge to help the bones grow together over time.
- The surgeon may insert small screws, rods, or plates to stabilize the joint and hold it in the correct position. These keep the bones from moving while fusion occurs.
- Once the bone graft is placed and hardware is secure, the surgeon closes the incision with sutures or staples.
- A bandage is applied to cover the wound.
Postoperative Care and Recovery
Postoperative care and recovery after facet joint fusion focus on pain management, wound care, and gradual return to activity. Patients may stay in the hospital for a day or two, depending on the extent of the surgery. Pain is typically managed with medications, and the surgical site must be kept clean and dry. A back or neck brace may be prescribed to support the spine during healing. Physical activity is limited initially, with walking encouraged to prevent complications like blood clots. Physical therapy often begins a few weeks after surgery to restore strength and mobility. Full fusion of the joint can take several months, during which regular follow-up appointments and imaging studies monitor healing progress. Most patients can return to light daily activities within a few weeks, though more strenuous activities should be avoided until full recovery is confirmed.
Risks and Complications
Facet joint fusion, like any surgery, carries potential risks and complications. These include:
- Infection
- Bleeding
- Blood clots
- Nerve damage
- Bone nonunion
- Hardware failure
- Persistent pain
- Adjacent segment disease
- Anesthesia-related risks