Facet Debridement Procedure – Risks & Complications
Today I would like to talk about the risks and complications and explain the procedure of facet debridement a little better.
You have had some blocks. You may have had some RF treatment for your painful facets and got some temporary relief. The purpose of this procedure is to make the facet joint pain relief permanent. I am going to show you in a moment how this is done, but the idea is to actually laser or thermocoagulate the nerves that go to the facet joints so that it is no longer temporary relief of pain but permanent relief of pain.
The idea is this: This is a lumbar spine, and the facets are these little joints in the back here. They kind of connect the vertebrae. The vertebrae are separated on the front side by the discs and on the back side they prevent rotation. If you were to twist your spine like at golf, there is actually some blockage here stopping so the facet joints are that. But also the other thing that happens with the facet joints is as the space here narrows, the joints here can get off center. They can get pinching the tissues inside them or stretching the capsule that covers them. So the operation is performed through a tube approximately this diameter; this is smaller than a dime. This is a little over 14 mm, and it is actually through an incision less than an inch. It is actually placed down on top of the facet joint like this, and then with a TV camera and the suction and all being put down the tube, I can actually get to various places on the facet joint; and with that I can actually get to the two places that are really important and that is the top of the facet joint here and the bottom of the facet joint where the nerves enter.
Also, a little capsule is taken which also prevents the recurrence of the pain, so this is essentially what is done during the procedure. What can go wrong with this? Well, really not too much. It is just simply a laser debridement of the soft tissues. Infection I guess can occur, incredibly rare. I have done thousands of these and I do not really know that I have seen but maybe one infection or maybe two, usually superficial where the stitches are. I have never seen a deep infection in this area. So, very rare, but I guess it could happen. Anytime you make a skin incision, an infection can happen. You might get a little stitch reaction as well; that is a possibility. Other than that, there are no real nerves to be injured here, other than the ones you are trying to intentionally injure.
You are not inside the spinal canal, so no risk or danger to the spinal cord or nerves. It is not really a complication, but it is a possibility, and that is that the operation does not completely relieve your pain, and you go “Well, Jeez, why would that be if we are cutting the nerves or lasering the nerves?” Well, the fact is that other things can cause back pain as well, and as I said in the beginning, probably the major reason that the facets are getting painful is the discs have started to degenerate to collapse, which can also be a significant contributor to back pain. So, you can get partial relief of the pain, but since we are not operating on the discs, that is a different kind of a problem. But I would say that would be the major reason that you would not get complete relief, which is not complication; it is a statistical. So this works depending on whether you do it in the lumber, thoracic, or cervical, depends on how much of pain, so probably about 65% to 68% of the time. I would expect at least 50% relief of the pain after two years.