Percutaneous Facet Fusion: A Minimally Invasive Approach to Spine Health

Percutaneous lumbar facet fusion is a minimally invasive surgical procedure designed to stabilize the lumbar spine by fusing specific facet joints. This procedure is typically performed under fluoroscopic guidance to ensure precise placement of implants and optimal surgical outcomes.

The procedure begins with the patient positioned prone on a radiolucent operating table. After sterile preparation and draping, fluoroscopic imaging is used to identify the target facet joints. Local anesthetic is administered to the skin and deeper tissues. Small skin incisions, typically 1-2 cm in length, are made bilaterally over the target facet joints.

Using fluoroscopic guidance, specialized instruments are advanced through the soft tissues to access the facet joints. Guide wires are placed across the facet joints to establish the optimal trajectory for implant placement. Sequential dilators may be used to create a working channel while minimizing tissue disruption.

The facet joints are then prepared by removing cartilage and decorticating the joint surfaces to promote fusion. This is accomplished using specialized instruments designed for minimally invasive access. Bone graft or bone graft substitute materials are placed within the prepared joint space to facilitate fusion.

Implants, typically specialized screws or devices designed for facet fusion, are then inserted across the prepared joints. These implants provide immediate stability and maintain proper alignment while fusion occurs. Final fluoroscopic images are obtained to confirm appropriate implant placement.

The procedure concludes with closure of the small incisions using subcuticular sutures. The minimally invasive nature of this technique typically results in less tissue trauma, reduced blood loss, and potentially faster recovery compared to traditional open fusion procedures.

Post-operative care includes pain management, early mobilization as tolerated, and appropriate activity modifications during the initial healing period. Patients typically undergo follow-up imaging to assess fusion progress and implant position.

Key advantages of this procedure include:

• Minimally invasive approach with smaller incisions

• Reduced soft tissue disruption

• Shorter hospital stay

• Potentially faster recovery

• Local or regional anesthesia options in select cases

• Preserved adjacent segment mobility

Potential candidates for this procedure include patients with chronic facet-mediated pain who have failed conservative management, facet joint instability, or specific degenerative conditions affecting the facet joints. Proper patient selection and careful pre-operative planning are essential for optimal outcomes.

Success rates vary but generally show favorable results in appropriately selected patients. Long-term outcomes depend on multiple factors including patient compliance with post-operative protocols, bone quality, and overall health status.

This procedure represents an important advancement in minimally invasive spine surgery, offering a less invasive alternative to traditional fusion techniques while maintaining the goal of achieving solid arthrodesis of the targeted facet joints.