Skip to main content
SpringerLink
Log in

Surgery of the Lumbar Facet Joints

  • Chapter
  • First Online:
Surgery of the Spine and Spinal Cord

  • 2098 Accesses

Abstract

The basic anatomic unit of the lumbar spine is a three-joint complex, comprised of an intervertebral disc and paired zygapophysial (facet) joints (Fig. 31.1a–c).

The main function of the facet joints is to limit movement in all planes of motion with a secondary role in weight bearing. Facet joints bear up to 25 % of axial loads under normal conditions and even greater loads in the presence of decreased disc height and in the cervical spine. Results of animal and cadaveric studies support the hypothesis that repetitive strain accumulated over a lifetime increases the risk for facet arthropathy, similar to other synovial joints. In humans, degenerative changes in any component of the anatomic unit predictably lead to concomitant degenerative changes in the other components. Since the risk for disc height reduction increases with age, facet joint arthropathy is also common in older adults. The existence of “facet joint syndrome” has long been questioned, but it is now generally accepted as a clinical entity, although not accurately defined.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Yang KH, King AI (1984) Mechanism of facet load transmission as a hypothesis for low-back pain. Spine (Phila Pa 1976) 9:557–565

    Article  CAS  Google Scholar 

  2. Ozaktay AC, Cavanaugh JM, Blagoev DC, Getchell TV, King AI (1994) Effects of a carrageenan-induced inflammation in rabbit lumbar facet joint capsule and adjacent tissues. Neurosci Res 20:355–364

    Article  CAS  PubMed  Google Scholar 

  3. Ozaktay AC, Cavanaugh JM, Blagoev DC, King AI (1995) Phospholipase A2-induced electrophysiologic and histologic changes in rabbit dorsal lumbar spine tissues. Spine (Phila Pa 1976) 20:2659–2668

    Article  CAS  Google Scholar 

  4. Little JS, Ianuzzi A, Chiu JB, Baitner A, Khalsa PS (2004) Human lumbar facet joint capsule strains: II. Alteration of strains subsequent to anterior interbody fixation. Spine J 4:153–162

    Article  PubMed  Google Scholar 

  5. Little JS, Khalsa PS (2005) Human lumbar spine creep during cyclic and static flexion: creep rate, biomechanics, and facet joint capsule strain. Ann Biomed Eng 33:391–401

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ianuzzi A, Little JS, Chiu JB, Baitner A, Kawchuk G, Khalsa PS (2004) Human lumbar facet joint capsule strains: I. During physiological motions. Spine J 4:141–152

    Article  PubMed  Google Scholar 

  7. Gotfried Y, Bradford DS, Oegema TR Jr (1986) Facet joint changes after chemonucleolysis-induced disc space narrowing. Spine (Phila Pa 1976) 11:944–950

    Article  CAS  Google Scholar 

  8. Panjabi MM, Krag MH, Chung TQ (1984) Effects of disc injury on mechanical behavior of the human spine. Spine (Phila Pa 1976) 9:707–713

    Article  CAS  Google Scholar 

  9. Haher TR, O’Brien M, Dryer JW, Nucci R, Zipnick R, Leone DJ (1994) The role of the lumbar facet joints in spinal stability. Identification of alternative paths of loading. Spine (Phila Pa 1976) 19:2667–2670, discussion 2671

    Article  CAS  Google Scholar 

  10. Adams MA, Freeman BJ, Morrison HP, Nelson IW, Dolan P (2000) Mechanical initiation of intervertebral disc degeneration. Spine (Phila Pa 1976) 25:1625–1636

    Article  CAS  Google Scholar 

  11. DePalma MJ, Ketchum JM, Saullo T (2011) What is the source of chronic low back pain and does age play a role? Pain Med 12:224–233

    Article  PubMed  Google Scholar 

  12. Manchikanti L (2004) The growth of interventional pain management in the new millennium: a critical analysis of utilization in the medicare population. Pain Physician 7:465–482

    PubMed  Google Scholar 

  13. Esses SI, Botsford DJ, Kostuik JP (1989) The role of external spinal skeletal fixation in the assessment of low-back disorders. Spine (Phila Pa 1976) 14:594–601

    Article  CAS  Google Scholar 

  14. Esses SI, Moro JK (1993) The value of facet joint blocks in patient selection for lumbar fusion. Spine (Phila Pa 1976) 18:185–190

    Article  CAS  Google Scholar 

  15. Jackson RP (1992) The facet syndrome. Myth or reality? Clin Orthop Relat Res 279:110–121

    Google Scholar 

  16. Dieppe PA, Lohmander LS (2005) Pathogenesis and management of pain in osteoarthritis. Lancet 365:965–973

    Article  CAS  PubMed  Google Scholar 

  17. Fujiwara A, Tamai K, An HS, Lim TH, Yoshida H, Kurihashi A, Saotome K (2001) Orientation and osteoarthritis of the lumbar facet joint. Clin Orthop Relat Res 385:88–94

    Google Scholar 

  18. Weishaupt D, Zanetti M, Boos N, Hodler J (1999) MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol 28:215–219

    Article  CAS  PubMed  Google Scholar 

  19. Van de Kelft E, Van der Planken D, Van de Kelft A, Melis K (2014) Validation of hybrid SPECT-CT in identifying the pain phenotype in patients with chronic low back pain. Pain Pract 14:80

    Google Scholar 

  20. Cohen SP, Huang JH, Brummett C (2013) Facet joint pain – advances in patient selection and treatment. Nat Rev Rheumatol 9:101–116

    Article  PubMed  Google Scholar 

  21. van Kleef M, Vanelderen P, Cohen SP, Lataster A, Van Zundert J, Mekhail N (2010) 12. Pain originating from the lumbar facet joints. Pain Pract 10:459–469

    Article  PubMed  Google Scholar 

  22. Cohen SP, Hurley RW, Christo PJ, Winkley J, Mohiuddin MM, Stojanovic MP (2007) Clinical predictors of success and failure for lumbar facet radiofrequency denervation. Clin J Pain 23:45–52

    Article  PubMed  Google Scholar 

  23. Makki D, Khazim R, Zaidan AA, Ravi K, Toma T (2010) Single photon emission computerized tomography (SPECT) scan-positive facet joints and other spinal structures in a hospital-wide population with spinal pain. Spine J 10:58–62

    Article  PubMed  Google Scholar 

  24. Wu M, Wang S, Driscoll SJ, Cha TD, Wood KB, Li G (2014) Dynamic motion characteristics of the lower lumbar spine: implication to lumbar pathology and surgical treatment. Eur Spine J 23:2350–2358

    Article  PubMed  Google Scholar 

  25. Malmivaara A, Slatis P, Heliovaara M, Sainio P, Kinnunen H, Kankare J, Dalin-Hirvonen N, Seitsalo S, Herno A, Kortekangas P, Niinimaki T, Ronty H, Tallroth K, Turunen V, Knekt P, Harkanen T, Hurri H, Finnish Lumbar Spinal Research G (2007) Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine (Phila Pa 1976) 32:1–8

    Article  Google Scholar 

  26. Weinstein JN, Lurie JD, Tosteson TD, Zhao W, Blood EA, Tosteson AN, Birkmeyer N, Herkowitz H, Longley M, Lenke L, Emery S, Hu SS (2009) Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am 91:1295–1304

    Article  PubMed  PubMed Central  Google Scholar 

  27. Khan AM, Girardi F (2006) Spinal lumbar synovial cysts. Diagnosis and management challenge. Eur Spine J 15:1176–1182

    Article  PubMed  PubMed Central  Google Scholar 

  28. Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE (2000) Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study. Spine (Phila Pa 1976) 25:556–562

    Article  CAS  Google Scholar 

  29. Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA, Birkmeyer NJ, Hilibrand AS, Herkowitz H, Cammisa FP, Albert TJ, Emery SE, Lenke LG, Abdu WA, Longley M, Errico TJ, Hu SS (2007) Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 356:2257–2270

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Mannion AF, Leivseth G, Brox JI, Fritzell P, Hagg O, Fairbank JC (2014) ISSLS prize winner: long-term follow-up suggests spinal fusion is associated with increased adjacent segment disc degeneration but without influence on clinical outcome: results of a combined follow-up from 4 randomized controlled trials. Spine (Phila Pa 1976) 39:1373–1383

    Article  Google Scholar 

  31. Van de Kelft E (2013) Lumbar facet resurfacing: first experience with the FENIX implant. J Spinal Disord Tech E-pub ahead of print

    Google Scholar 

  32. Meisel H-J, Seller K, Lϋth A, Bϋttner-Janz K, Stosberg P, Moser A, Miller LE, Block JE, Pimenta L (2014) Minimally invasive facet restoration implant for chronic lumbar zygapophysial pain: 1-year outcomes. Ann Surg Innov Res 8:7

    Article  PubMed  PubMed Central  Google Scholar 

  33. Weishaupt D, Zanetti M, Hodler J, Boos N (1998) MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology 209:661–666

    Article  CAS  PubMed  Google Scholar 

  34. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 26:1873–1878

    Article  CAS  Google Scholar 

  35. Modic MT, Masaryk TJ, Ross JS, Carter JR (1988) Imaging of degenerative disk disease. Radiology 168:177–186

    Article  CAS  PubMed  Google Scholar 

  36. Wiltse LL, Bateman JG, Hutchinson RH, Nelson WE (1968) The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg Am 50:919–926

    CAS  PubMed  Google Scholar 

  37. Wiltse LL (1973) The paraspinal sacrospinalis-splitting approach to the lumbar spine. Clin Orthop Relat Res 91:48–57

    Google Scholar 

  38. Anand N, Baron EM, Bray RS Jr (2008) Modified muscle-sparing paraspinal approach for stabilization and interlaminar decompression: a minimally invasive technique for pedicle screw-based posterior nonfusion stabilization. SAS J 2:40–42

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, AZ Nikolaas, Sint Niklaas, Belgium

    Erik Van de Kelft MD, PhD

Authors
  1. Erik Van de Kelft MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Erik Van de Kelft MD, PhD .

Editor information

Editors and Affiliations

  1. Dept. of Neurosurgery, AZ Nikolaas, Sint-Niklaas, Belgium

    Erik van de Kelft

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Van de Kelft, E. (2016). Surgery of the Lumbar Facet Joints. In: van de Kelft, E. (eds) Surgery of the Spine and Spinal Cord. Springer, Cham. https://doi.org/10.1007/978-3-319-27613-7_31

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-27613-7_31

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27611-3

  • Online ISBN: 978-3-319-27613-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation