Facet Joint Replacement: Intermediate- and Long-Term Outcome in a Large Case Series

Abstract

Background The long-term outcome of facet joint replacement (FJR) still is to be proven. Methods We present a prospective case series of 26 (male-to-female ratio of 1:1; mean age: 61 years) patients undergoing FJR with a follow-up of at least 1 year (range: 12–112; mean: 67 months). Visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and the 12-Item Short Form Health Survey (SF-12) were applied pre- and postoperatively (after 3, 6, and 12 months) as well as at the last follow-up (N = 24). Using X-rays of the lumbar spine (N = 20), the range of motion (ROM) and disk height in the indicator and adjacent levels were assessed. Results FJR was performed at L3/L4 (N = 7), L4/L5 (N = 17), and L5/S1 (N = 2). Mean VAS (mm) for back pain decreased from 71 to 18, mean VAS for right leg pain from 61 to 7, and from 51 to 3 for the left leg. Mean ODI dropped from 51 to 22% (for all p < 0.01). Eighty seven percent of patients were satisfied and pretreatment activities were completely regained in 78.3% of patients. Disk height at the indicator and adjacent levels and ROM at the indicator segment and the entire lumbar spine were preserved. No loosening of implants was observed. Explantation of FJR and subsequent fusion had to be performed in four cases (15.4%). Conclusions In selected cases, long-term results of FJR show good outcome concerning pain, quality of life, preservation of lumbar spine motion, and protection of adjacent level.

Lumbar facet joint stabilization for symptomatic spinal degenerative disease

“…Inflexible spinal fusion can lead to overloading of nonfused segments, increasing like the hood of adjacent segments disease and thus causing pain, wound problems, infections, pseudoarthrosis, and implant failure. [ 12 16 ] Therefore, alternative spinal implants were developed, in order to preserve the ROM.…”

“…In patients with intact segmental lumbar disk and symptomatic spinal canal stenosis exclusively caused by facet joint hypertrophy, the concept of “Facet joint Replacement” (FJR) is a promising alternative to monosegmental lumbar fusion. [ 16 ] Recently, the intermediate- and long-term results of an FJR in 26 patients affected by spondyloarthropathy and intact segmental lumbar disk have been presented. [ 16 ] The dynamic system of FJR showed good results in pain relief, assessed by ODI, VAS back and leg pain scores.…”

“…[ 16 ] Recently, the intermediate- and long-term results of an FJR in 26 patients affected by spondyloarthropathy and intact segmental lumbar disk have been presented. [ 16 ] The dynamic system of FJR showed good results in pain relief, assessed by ODI, VAS back and leg pain scores. This surgical intervention has been shown to improve the patient QoL, and preserve the lumbar spine motion in a follow-up spanning 12 months.…”

“…In selected patients, FJR seems to be an alternative to rigid fusion in preventing adjacent level disease, improving back and leg pain, and enhancing patient's QoL. [ 16 ]…”