Most cases of facet joint osteoarthritis never require surgery. However, if a patient's symptoms are severe and other treatments have failed to provide relief, spinal surgery may be considered.

Two of the most commonly performed surgeries for patients with severe spine osteoarthritis are vertebral fusions and laminectomies.

Vertebral Fusion

Patients with severe facet osteoarthritis may experience painful friction between the facet joints. Fusing two or more vertebrae together can eliminate this friction.

Total fusion is not achieved during surgery. Instead, the surgeon creates the opportunity for the vertebrae to grow together. The surgeon will place a bone graft between two vertebrae and secure them together using screws, rods or other hardware. After a successful surgery it typically takes 3 to 6 months, but possibly as long as 18 months, for the bone graft and vertebrae to grow together.

Patients should be aware that fusion surgery decreases the spine's flexibility and may put more pressure on surrounding soft tissue and facet joints. Patients and doctors must weigh the benefits of surgery against the risk of future problems it creates.

Vertebral fusion is often done in conjunction with a discectomy, or removal of a vertebral disc.

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Laminectomy

Osteoarthritis can cause the spinal canal to narrow and impinge on the spinal cord and nerve roots, causing pain, numbness and weakness in the arms and hands or legs and feet. In fact, the nerve pain in the extremities may be worse than the back pain.

The goal of a laminectomy, sometimes called decompression surgery, is to create more space for the neural material, thereby reducing or alleviating symptoms.

During a laminectomy, a surgeon removes a part of the vertebra called the lamina, which comprises the backside of the spinal canal. The surgeon must also remove the spinous process, the part of the vertebra that protrudes out and can be felt through the skin. The surgeon may also trim any boney growths on the vertebra.

Depending on the patient's condition, one or more lamina may be removed. This procedure may be done in conjunction with a vertebral disc repair or fusion surgery.

A laminectomy may relieve symptoms but cannot prevent future facet joint osteoarthritis or other spinal degeneration, so it is possible that symptoms may gradually return.

Deciding on Surgery for Osteoarthritis

Laminectomy and bone fusion surgery are typically elective, meaning it is up to the patient to decide whether or not to have surgery. Patients are advised to get a second or even third opinion before deciding if surgery is the best option.

For most patients, committing to an extensive and rigorous nonsurgical treatment program, which typically includes rehabilitative physical therapy and exercise, will help them avoid the need for back or neck surgery.

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