A facetectomy is a spinal surgical procedure for people who experience moderate to severe sciatic pain as a result of an impinged spinal nerve. Spinal nerves become impinged when they are being pinched. This could be caused by many things, including the facet joints, a disc herniation, or thickening of the ligament. By removing a portion of one or more vertebrae, surgeons completing a facetectomy aim to relieve the pressure on spinal nerves which relieves pain and other related symptoms.1 The procedure is sometimes referred to as a medial facetectomy, partial inferior facetectomy, or a total facetectomy, depending on location and diagnosis.
Purpose of Procedure
A facetectomy may be recommended if you have been experiencing pain, numbness, and tingling as a result of 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 good candidate for a facetectomy, the procedure may be considered if symptoms have not responded to conservative treatment, like physical therapy, after several months, or if walking or standing becomes difficult. The persistence of severe symptoms despite an adequate course of non-operative treatment point toward surgery as the next treatment option.
A facetectomy is not a procedure to relieve pain related to uncomplicated arthritis or simple fractures of the spine. You must experience neurologic changes in one or both legs in order to necessitate surgery.
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 any surgery, there are associated risks to consider. For example, someone who undergoes a facetectomy is at risk for infection, bleeding, and/or further injury to the nerve.
Facetectomies also place you at risk for spinal nerve damage. Despite these risks, a facetectomy is a relatively common procedure and such complications are rare.
Long-term risks of facetectomy include spinal instability, changes in sensation, and other symptoms which may impact function.2
A facetectomy is contraindicated in people without spinal nerve issues. It is also contraindicated for those who have an unstable spinal column or spinal deformities which would complicate surgery.2 A facetectomy is also contraindicated in people with tissue or skin infections where the surgery would take place, and in elderly individuals who have complex medical diagnoses or histories.
Before the Procedure
Your doctor 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 good candidate for a facetectomy. Once your doctor determines you are a good candidate for a facetectomy, you will be scheduled for the surgery.
Your doctor 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 doctor 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.3
It is a good idea to arrive early for any medical procedure, as there is often a period allotted for filling out forms while preparing you for the surgery. 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.
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 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 which 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 doctor’s orders.
In the recovery room of your facility, you will have the chance to eat and drink while waiting for the effects of the anesthesia to wear off. Your doctor will inform you when to resume certain medications after the surgery.
According to your tolerance and preference, you are able to resume a normal diet once the surgery is over. Some patients experience nausea or digestive discomfort due to the anesthesia, however, nurses will monitor your recovery and encourage fluid intake and food to assist.
Cost and Health Insurance
The cost of a facetectomy ranges from $8,000 to $12,000. Where exactly your cost falls in this range depends on the location of the surgery. Cost are lower for individuals who opt to have the procedure done in an outpatient surgical facility where they return home shortly after. Those individuals who choose to stay inpatient (overnight) in a hospital will have higher medical bills.
Insurance coverage will greatly range depending on your plan. This procedure does require pre-approval from health insurance plans, as is required for most surgical procedures. Receiving pre-approval from your health insurance plan also means you or your healthcare proxy will be involved in discussions regarding your out-of-pocket costs, if any.
What to Bring
Bring your insurance card, identification, and paperwork with you to the procedure. Check with restrictions on electronic devices in the pre-surgery or recovery areas. If you are staying overnight, bring comfortable nightclothes and slippers if you wish to wear your own.
You will be instructed to arrange for transportation home after your surgery, since anesthesia often temporarily impairs the ability to drive.
During the Procedure
You will be interacting with your surgeon, anesthesiologist, and nursing staff.
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 still medically stable to go through with the surgery.
Throughout the Procedure
Most facetectomies will use general anesthesia rather than local anesthesia. General anesthesia means you will not be awake nor will you feel pain during this procedure. The facetectomy surgery will take one to two hours, depending on the angle and amount of damage to the spinal vertebrae.
Again, this will vary based on if you are in an outpatient or inpatient facility. 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 nurses and doctors may even 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 these same 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 several weeks after your surgery. This is normal and you should allow your body to rest and recover from the surgery.
Your doctor 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.4 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.
You are expected to notify your doctor if you experience any significant pain, bleeding, or difficulty passing urine after your surgery. You should also notify your doctor if your incision site reopens, oozes pus, and/or has a foul odor.
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 a follow-up appointment with your doctor. Your doctor will often wait until this appointment to clear you to drive, return to work, and resume your typical activities.
Your doctor 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 doctor may increase this to 20 pounds or lift the restriction altogether, depending on how you are progressing.
If you have risk factors which will complicate the healing process and increase your risk for further injury, your doctor will coach you regarding those issues. For example, being overweight has a large impact on spinal health and overall mobility. Your doctor will provide recommendations and instructions to work toward losing weight, if applicable. Your doctor may also tell you to stick to a healthy diet, quit smoking, and begin light exercises to maximize the benefits of your surgery.
Depending on your level of function and overall medical condition, your doctor may consider a repeat facetectomy for additional vertebrae if your pain and numbness persist. This will be discussed after your first follow-up appointment following supplements such as rehabilitation therapies and lifestyle changes.
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 a procedure such as surgery. Eating a balanced diet, exercising as you are able, losing weight, and quitting smoking are just some conservative methods to improve nerve compression symptoms such as pain and numbness. These methods are not the only option for pain relief; however, they strongly complement surgical procedures such as a facetectomy.