What Is a Facetectomy?

A facetectomy is a spinal surgical procedure for people who experience moderate to severe pain as a result of an impinged (pinched) spinal nerve. This could be caused by problems such as narrowing of the facet joints or disc herniation. A facetectomy is done to relieve pressure on spinal nerves, which relieves pain and other related symptoms. Different facetectomy procedures include medial facetectomy, partial inferior facetectomy, or total facetectomy, depending on the location and type of nerve impingement.

Purpose of Procedure

A facetectomy may be recommended for treatment of pain, numbness, and tingling that's caused by spinal nerve impingement due to degenerative disc disease and spondylosis, bone spurs, spinal fractures, worn-away facet cartilage (called facet joint syndrome), or a narrowing of the spinal canal (called stenosis).

While not everyone with these conditions is a candidate for a facetectomy, the procedure may be considered if symptoms have not responded to conservative treatment, like physical therapy, or if walking or standing becomes difficult.

A facetectomy is not to be confused with a spinal fusion, a surgery in which two or more spinal vertebrae are fused together. Spinal fusion is performed to stabilize an unstable spinal segment.

Risks and Contraindications

As with most surgeries, fasciotomy has a risk for infection or bleeding. A facetectomy also places you at risk for new or worsened spinal nerve damage. Despite these risks, a facetectomy is a relatively common procedure and such complications are rare.

Long-term complications include spinal instability, changes in sensation, and other symptoms which may impact function.

Contraindications

A facetectomy is contraindicated for those who have an unstable spinal column or spinal deformities that would complicate surgery.

If you have a tissue or skin infection where the surgery would take place, your surgery may be postponed until the infection resolves.

This surgery can be too high of a risk for individuals who have complex underlying medical issues.

Before the Procedure

Your healthcare provider will complete laboratory tests, conduct a thorough medical history, review your medications with you, and complete strength and nerve function tests before determining if you are a candidate for a facetectomy.

Before your surgery, your healthcare provider will advise you to stop taking certain medications, namely blood-thinning medications and supplements, just before the surgery. These medications may increase your risk of bleeding during and after the surgery.

If you are an active smoker, your healthcare provider will also ask you to stop smoking. This is because smoking significantly slows the healing process and increases your risk of experiencing continued pain after the surgery.

Timing

Depending on the type of facetectomy—total facetectomy, medial facetectomy, or partial facetectomy—the surgery will vary in length. It typically takes one to two hours.

Location

A facetectomy typically takes place in a hospital or outpatient surgical center. Once the surgery is complete, you will be taken to a separate recovery to have your vital signs monitored for several hours.

What to Wear

There are no restrictions regarding clothing, as you will fully undress and wear a hospital gown for the surgery. Bring comfortable clothes that are easy to put on after the surgery.

Food and Drink

Fasting for around 12 hours before the surgery is usually expected, but this number will vary depending on your condition and healthcare provider’s orders.

In the recovery room of your facility, you will have the chance to eat and drink. Your healthcare provider will inform you when to resume certain medications after the surgery.

According to your tolerance and preference, you will able to resume a normal diet once the surgery is over. Some people experience nausea or digestive discomfort due to the anesthesia. Your nurses will monitor your recovery and guide your food and fluid intake safely.

Cost and Health Insurance

The cost of a facetectomy ranges from $8,000 to $12,000. Costs are lower for individuals who have the procedure done in an outpatient surgical facility and return home shortly after. Those individuals who need to stay inpatient (overnight) in a hospital may have higher medical bills.

Insurance coverage will vary depending on your plan. This procedure, like most surgeries, requires pre-approval from health insurance plans. You might have to pay a copay portion for your procedure. It's best to check In advance so you will be prepared.

What to Bring

Bring your insurance card, identification, and paperwork with you to the procedure. Check about specific restrictions on electronic devices in the pre-surgery or recovery areas. If you are staying overnight, you can bring comfortable nightclothes and slippers if you wish to wear your own.

During the Procedure

On the day of your surgery, you will register, and then go to a pre-operative area.

Pre-Surgery

You will begin by checking in with a nurse or medical assistant who will take your vitals and instruct you to change into a gown. You may have to wait for a bit, then you will be transported to the pre-surgery room where you will undergo short tests to ensure you are medically stable to go through with the surgery.

Throughout the Procedure

Most facetectomies will use general anesthesia, which means you will not be awake nor will you feel pain during this procedure.

Your surgeon will make a small skin incision, and then may need to move muscle out of the way to gain access to the damaged or narrow facets. They will remove as little bone as possible to release pressure from the nerve.

Sometimes other spinal procedures, such as stabilization of a herniated disc.

Your incision will be closed and covered with bandages.

The facetectomy surgery will take one to two hours, depending on the angle and amount of damage to the spinal vertebrae.

Post-Surgery

Nurses and medical staff will monitor you following the surgery. If you are in an outpatient facility, you will remain in the recovery room for an hour or two while nurses monitor your vitals, alertness, pain levels, and ability to pass urine.

Your healthcare providers may complete strength and basic range of motion tests to ensure the surgery was successful.

If you are at an inpatient facility, you will stay the night and undergo tests and monitoring from your medical staff. Inpatient facilities may also include a visit or two from a physical and occupational therapist to begin basic strengthening exercises if you are cleared by your surgeon.

After the Procedure

Depending on your recovery and level of function, you may spend several days in the hospital or return home after one day. You should expect to feel quite sore for several weeks after your surgery. This is normal and you should allow your body to rest and recover from the surgery.

Your healthcare provider will instruct you to walk short distances immediately after your surgery. You will then be encouraged to gradually walk more and more until you can walk as you previously did. This independent walking program will often be supplemented by physical and occupational therapy programs to assist you in regaining your strength, motion, and level of functioning.

Results and Follow-Up

If you have staples at the incision site, they are usually removed one to two weeks following your surgery during your follow-up appointment with your surgeon. Your surgeon will often wait until this appointment to clear you to drive, return to work, and resume your typical activities.

Your surgeon will also limit you to lifting less than 10 pounds for the first several weeks after your surgery. Once you attend your follow-up visit, your surgeon may increase this to 20 pounds or lift the restriction altogether, depending on how you are progressing.

Physical therapy and guided therapy will continue during and after post-surgical healing.

A Word From Verywell

Any medical procedure, especially surgery, is taxing on a person’s emotional and physical health. It is important to become well-informed and educated regarding the options and treatment methods available to you. It is also important to recognize there are steps you should take to improve your own health apart from the procedure. Eating a balanced diet, exercising as you are able, losing weight if you're overweight, and quitting smoking can help you maximize the benefits of your surgery.