The Biomechanics of Lumbar Facetectomy Under Compression-flexion

Alterations of posterior spinal elements including the facet joints are commonly associated with a variety of lumbar operative procedures. Under continuous physiologic compression-flexion load application L2-L3 and L4-L5 functional units were tested as intact preparations and then sequentially altered with unilateral facetectomy, bilateral facetectomy, posterior ligament transection, and partial discectomy. Using a method of continuous motion analysis, the movement of the individual spinal components (disc, facet joint, interspinous process distance) were statistically compared between the various surgical alterations. Higher physiologic loads produced significant increases in overall deflection from BF to BFL alterations indicating a preference to preserve the posterior ligaments for this surgical approach. Although insignificant changes in the force-deflection response from one surgical alteration to the next sequential alteration were noted, statistically significant increases in localized facet joint motion may suggest the potential for acceleration of segmental degenerative changes.