1. Facet Disease Surgery & the Conservative Treatments that Precede it
Facet disease surgery is often viewed as a treatment of last resort, as
most patients are able to find relief by utilizing conservative,
noninvasive methods. Some patients who are unable to obtain relief
with the assistance of noninvasive treatments may qualify to receive
a minimally invasive, outpatient procedure in lieu of traditional open
spine surgery. In order to thoroughly understand how and why facet
disease surgery is performed, it is essential for patients to have a
basic understanding of what the condition is and how it develops.
Facet Disease – An Overview
Facet disease is a type of arthritis that involves the gradual deterioration of the cartilage that lines the
joints in the neck and back. The condition initially presents with stiffness and mild pain, especially first
thing in the morning and after long periods of rest. As the joints further deteriorate, patients can
experience pain on a more frequent basis, as well as loss of mobility, the sensation of bones rubbing
against one another, and inflammation.
Patients may develop osteophytes (bone spurs), which the body creates in an effort to prevent the
bone-on-bone contact that arises when a joint is devoid of cartilaginous lining. Osteophytes may extend
into the spinal column, causing compression of the spinal cord or a nerve root. This may lead to
additional symptoms of pain, tingling, numbness, and muscle weakness in the neck, back, shoulders,
hips, and/or extremities. Facet disease surgery may become necessary if a spinal nerve requires
decompression to alleviate the patient’s nerve-related symptoms.
As facet disease progresses, other anatomical components of the spine can also suffer, including:
• Vertebrae – Vertebrae are the bone structures that house and protect the spinal cord. Adjacent,
articulating vertebrae are connected by facet joints. When the facet joints have deteriorated to
the point that they are no longer able to properly support the vertebrae, patients are
susceptible to developing spondylolisthesis (the misalignment of one or more vertebrae) and
other spinal conditions.
• Intervertebral discs – Positioned between adjacent vertebrae, intervertebral discs act as shock
absorbers by reducing the weight and impact that is placed on the vertebrae. When the
vertebra directly above or below an intervertebral disc is compromised because of a lack of
support from the facet joints, excess pressure can be placed on the disc. This may lead to
herniated discs, bulging discs, and/or degenerative disc disease.
Conservative Treatments for Facet Disease
Before a doctor or spine specialist asks a patient to consider facet disease surgery, he or she will first
prescribe a regimen of conservative treatments. This will almost always entail the use of medication,
namely over-the-counter, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin, or
naproxen. NSAIDs relieve pain and inflammation by blocking the body’s creation of COX-1 and/or COX-2
enzymes. Some patients may not be able to take NSAIDs, usually because of a medical condition that
affects the heart or gastrointestinal tract or because of how NSAIDs interact with medications the

2. patient is already taking. A physician may prescribe pain relievers or muscle relaxants for these patients
and also for patients whose pain and inflammation does not subside while using NSAIDs.
Many patients also benefit from working with a physical therapist to strengthen specific muscles and
ligaments in the neck and back. Having stronger supporting tissues can help to relieve some of the
pressure that is being placed on the facet joints as well as on any spinal nerves that are being
compressed by a bone spur. In addition to strength training, physical therapists may utilize other
techniques, including:
• Massage therapy – Massage is effective at reducing the tension that can develop in muscles that
are overworked. This can help to relieve any pressure that may be contributing to neural
compression in the neck or back.
• Hot/cold therapy – Applying a heating pad will increase blood flow to the area which can
promote healing. A cold compress, on the other hand, will help to numb pain and reduce
inflammation.
• TENS – An acronym for transcutaneous electrical nerve stimulation, TENS is performed by
affixing diodes to specific points on the neck or back. These diodes are connected to a small box
that controls the amount of electrical current that is delivered to the patient. This type of
therapy can help to scramble nerve signals, thereby reducing pain.
Alternative Therapies for Facet Disease
Some patients benefit from complementing their doctor-prescribed
conservative treatments with alternative therapies. These treatments
are also sometimes utilized by patients who have attempted all
conservative treatments and are facing imminent facet disease
surgery.
The popular alternative therapies for facet disease and other spinal
conditions that cause chronic back or neck pain include:
• Acupuncture – Acupuncture involves the insertion of very small needles into meridians, or
specific points, on the body. This practice is said to reduce pain by scrambling nerve signals and
increasing the body’s production of endorphins.
• Herbs and nutritional supplements – Some herbs can help to lubricate joints, reduce
inflammation, and relieve pain, all of which can benefit patients who suffer from facet disease.
An herbal nutritionist should be consulted to ensure optimal results are achieved.
• Pilates – This type of exercise involves strengthening the core muscles in the back and abdomen.
As with the strength training exercises that are utilized during physical therapy, Pilates can help
to reduce the strain that is placed on spinal nerves, intervertebral discs, vertebrae, and other
anatomical components that are inadvertently affected by damaged facet joints.
It is important to note that not all forms of alternative therapy have received a stamp of approval from
the general medical community as their efficacy is still up for debate.
Facet Disease Surgery

3. Most physicians recommend that patients attempt conservative, noninvasive treatments for at least a
few weeks or months before pursuing surgery. The vast majority of patients who suffer from facet
disease are able to find relief from noninvasive treatments, making facet disease surgery unnecessary
for most patients. In the event that a patient does qualify for surgical treatment, he or she can typically
choose between two different procedures: open spine surgery and an endoscopic procedure.
Open spine surgery for facet disease requires that a long incision is made in
the patient’s neck or back. The affected facet joint is then accessed and a
spinal fusion procedure is performed. A bone graft and stabilizing hardware
are used to prevent further articulation in the joint. This is often followed by
a lengthy hospital stay and an arduous rehabilitation that can take up to a
year for some patients.
Endoscopic procedures are usually performed on an outpatient basis. A very
small incision (typically one inch or less) is made in the neck or back and an
endoscope is used to access the affected facet joint. A laser is then used to
deaden the nerves that travel through the joint, similarly to how an oral root
canal is performed. Some patients experience immediate pain relief and
many are able to return to daily activities within two weeks.
Both open spine facet disease surgery and minimally invasive procedures come with inherent risks and
benefits. Patients should take care to discuss all options with a doctor or spine specialist before
consenting to any procedure.