Predictors of facet joint syndrome after lumbar disc surgery

Postoperative facet joint syndrome (pFJS) requiring intervention is a common problem following lumbar disc surgery (LDS). The aim of this retrospective study was to identify possible predictors, surgical aspects or individual characteristics that may contribute to the development of pFJS and may allow prevention of this frequent postoperative problem. We included 509 patients who underwent open, microsurgical discectomy in our neurosurgical department between 2006 and 2009 and who presented to our outpatient clinic for follow-up. We recorded gender, age, preoperative and postoperative clinical and neurological status, surgical technique, duration of the surgical procedure, disc herniation relapse, rehabilitation treatment and development of pFJS. Forty-three patients (8.4%) developed clinically evident pFJS, confirmed by a successful facet joint injection. Patients with pFJS were significantly older than those without pFJS (55.7 years compared with 50.9 years; p=0.03) and had more frequent recurrent disc herniation (p=0.001). Furthermore, the duration of the surgical procedure (p=0.01), intraoperative and postoperative complications (for example, postoperative bleeding, dural injury; p=0.001) and general comorbidity (p=0.001) were associated with pFJS. In addition, an extended discectomy compared with sequesterotomy (p=0.049) and rehabilitation treatment compared with no rehabilitation (p=0.019) were correlated to pFJS in the multivariate analysis. Thus, we were able to identify factors associated with the development of pFJS following LDS: advanced age, long operative time, intraoperative complications, history of recurrent disc prolapse, discectomy and lack of rehabilitation. Our results characterize a profile for patients at high risk for the development of clinically evident pFJS.