Total lumbar facetectomy without fusion

short and long term follow-up in a single surgeon series

Mark A. Pichelmann, John L.D. Atkinson, Nicolee C. Fode-Thomas, Michael J Yaszemski

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Total lumbar facetectomy may be advantageous for exposure or to completely free a constricted nerve root. Objective: We retrospectively reviewed a single surgeon series without fusion for short and long term outcomes regarding radicular pain relief, subsequent relevant surgeries, and any identifiable instability. Methods: All operations in which a single, total lumbar facetectomy was performed were reviewed. A total of 222 patients were identified with a minimal follow-up of 3 months; 187 (84.2%) were available for long term follow-up ≥1 year by continued accessible health care records, correspondence, or mailed questionnaire. Results: Short term success (3-month follow-up) for radicular pain relief in 222 patients found the following results: 176 patients (79.3%) had no pain or minimal pain, and 16 patients (7.2%) were improved, and thus resulting in 192 (86.5%) with no pain, or improved radicular pain. 30 patients (13.5%) were postoperative failures at 3 months. Long term follow-up ≥1 year was available for 187 patients (84.2%); (range 1–17 years; mean 7 years); found the following results: 23/30 (76.6%) short term surgical failures remained failures in long term follow-up with (7 patients) or without (16 patients) further surgery of any kind; 13/16 improved patients at long term follow-up remained improved (6), were pain free (6), or worse (1); 19/151 no or minimal pain patients at long term follow-up recurred or worsened by 1 year or longer, 12/19 pursued a second surgery with (9) or without (4) fusion and many improved. A total of 13 patients had a subsequent fusion operation (6.95%). Discussion: Most patients do well in the short term for radicular pain relief. Most patients continue to do well in long term follow-up. Surgically induced clinical instability is uncommon in this highly selected series.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalBritish Journal of Neurosurgery
DOIs
StateAccepted/In press - Apr 24 2017

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Pain
Surgeons
Delivery of Health Care

Keywords

  • Lumbar disc surgery
  • lumbar radiculopathy
  • lumbar spine surgery
  • spine surgery
  • total facetectomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Total lumbar facetectomy without fusion : short and long term follow-up in a single surgeon series. / Pichelmann, Mark A.; Atkinson, John L.D.; Fode-Thomas, Nicolee C.; Yaszemski, Michael J.

In: British Journal of Neurosurgery, 24.04.2017, p. 1-7.

Research output: Contribution to journalArticle

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abstract = "Background: Total lumbar facetectomy may be advantageous for exposure or to completely free a constricted nerve root. Objective: We retrospectively reviewed a single surgeon series without fusion for short and long term outcomes regarding radicular pain relief, subsequent relevant surgeries, and any identifiable instability. Methods: All operations in which a single, total lumbar facetectomy was performed were reviewed. A total of 222 patients were identified with a minimal follow-up of 3 months; 187 (84.2{\%}) were available for long term follow-up ≥1 year by continued accessible health care records, correspondence, or mailed questionnaire. Results: Short term success (3-month follow-up) for radicular pain relief in 222 patients found the following results: 176 patients (79.3{\%}) had no pain or minimal pain, and 16 patients (7.2{\%}) were improved, and thus resulting in 192 (86.5{\%}) with no pain, or improved radicular pain. 30 patients (13.5{\%}) were postoperative failures at 3 months. Long term follow-up ≥1 year was available for 187 patients (84.2{\%}); (range 1–17 years; mean 7 years); found the following results: 23/30 (76.6{\%}) short term surgical failures remained failures in long term follow-up with (7 patients) or without (16 patients) further surgery of any kind; 13/16 improved patients at long term follow-up remained improved (6), were pain free (6), or worse (1); 19/151 no or minimal pain patients at long term follow-up recurred or worsened by 1 year or longer, 12/19 pursued a second surgery with (9) or without (4) fusion and many improved. A total of 13 patients had a subsequent fusion operation (6.95{\%}). Discussion: Most patients do well in the short term for radicular pain relief. Most patients continue to do well in long term follow-up. Surgically induced clinical instability is uncommon in this highly selected series.",
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