Board Certified Neurosurgeon Brain & Spine Care 860-889-9035
Mark Hornyak, MDBoard Certified Neurosurgeon
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Degenerative / Spine Case

Facet Joint Arthroplasty

65 yo man with 9 mo of severe LBP

Description

65 yo man with 9 mo of severe LBP
• Min 3/10; avg 7/10; max 8/10
Radiates to posterior thighs with walking
Leg pain 5/10
ODI 11/50 = 22% disability
Improved with walking bent forward
No neurological symptoms
Epidural steroid injection – brief relief
Offered fusion by another surgeon

Gallery

Images

Figure 1Patient's self-reported pain diagram. Reporting back pain 7/10, leg pain 5/10. ODI 11/50 equals 22% disabled.
Figure 2MRI lumbar spine demonstrating L4-5 spondylolisthesis with stenosis and severe facet degeneration.
Figure 3X-ray lumbar spine (AP & lateral) showing spondylolisthesis at L4-5
Figure 4Flexion-extension x-rays showing movement at L4-5. Extension x-ray (left) shows spondylolisthesis measuring approximately 5 mm which increases to 11 mm in extension (right)
Figure 5Intraprocedural fluoroscopy showing diagnostic medial branch blocks. Patient received 80% relief from both 1st and 2nd injection.
Figure 6Intraoperative photo showing placement of pedicle screw that will anchor the facet arthroplasty device to the spine. This particular tool confirms that the angulation of the screw is acceptable.
Figure 7Screen capture from intra operative navigation showing placement of right L5 pedicle screw.
Slide 8Postop x-ray AP with right and left lateral bending. Shows movement of the device with patient bending to the left and the right.
Figure 9Lateral flexion-extension x-rays show function of the device during flexion extension. Angle of the screws decreases from approximately 22 degrees with extension to 13 degrees in flexion.
Figure 10Postop pain diagram. Patient reporting 0 pain and no disability.
Figure 11Diagram of the TOPS facet arthroplasty device from Premia Spine

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