INTRODUCTION:
The Facet Screw System is intended to stabilize the spine as an aid to fusion by transfacet fixation.
The device is indicated for posterior surgical treatment of any or all of the following at the L1 to S1 (inclusive) spinal levels: Spondylolisthesis, Pseudoarthrosis or failed previous fusions which are symptomatic; Degenerative Disc Disease (DDD) as defined by back pain of discogenic origin with degeneration of disc confirmed by history and radiographic studies and/or degenerative disease of the facets with instability.

PATIENT INFORMATION:

Lumbar Facet Fusion
Each vertebra in the spine joins its neighbor via three joints – the large disc in the front and two small facet joints behind, forming a triangle of joints surrounding the spinal canal. The facet joints are also sometimes called zygapophyseal joints.
The facet joints are most commonly affected by osteoarthritis (wear and tear arthritis). Facet joint pain can be felt over the affected joint but can also be referred – to the shoulder girdle, shoulder blade or arm in the case of the neck, or into the bony pelvis, hip or thigh in the case of the low back. It tends to be worse with extension of the spine (bending backwards).
Plain x-rays, CT or MRI scans can identify facet joint disease but sometimes the most sensitive test is a nuclear bone scan (see figure), which can identify facet joint problems when the other tests appear less obviously abnormal.
Each patient has different abilities and needs, therefore your doctor will determine if you are a candidate for a lumbar facet fusion.
Lumbar facet fusion is like fixing a broken bone, aiming to join one vertebra (spinal bone) to another. It takes six months to two years for the bones to knit [fuse]. In the meantime, your screws and rods keep the fusion site solid. Your recovery will need supervision with a physiotherapist, plus some common sense, to balance between trying to mobilize the lumbar (low back) joints that aren’t fused, and trying not to put too much stress on the fusion site until it is fused.

Expectations
Be realistic and don’t expect too much. Your back will never be as good as new. It is unusual to be totally cured of pain and to not be left with some lumbar pain and/or pain in the buttocks, hips or thighs. The aim of surgery is to get significant improvement in your symptoms.

Posture
Low back advice after surgery applies to you as to everybody in the community. The best posture is keeping your low back as vertical as possible, like a column of bricks – e.g. bend your knees to get low to the ground rather than bending your low back. Try to minimize bending (forwards, backwards or sideways) and twisting, especially if you are carrying something. However, (and this sounds contradictory) postoperatively you will be encouraged to try to mobilize your low back so that it does not become stiff at the unoperated levels. Postoperatively you can sit as soon and long as you like, until it becomes uncomfortable. You can drive as soon as you wish but this may be painful and it would be preferable if you were driven by someone else early on.

Brace
A light lumbar support may be used postoperatively for additional pain relief. You are encouraged to do away with the brace as soon as possible (0-3 weeks), or only use it intermittently, because you will be encouraged to strengthen and mobilize your trunk (back and abdominal) or core muscles.

Smoking
There is absolutely no doubt that smoking reduces the success rate of fusion. Smoking interferes with the development of new blood vessels that are essential for developing new bone.

Physical therapy
Your physiotherapist will supervise you postoperatively and will make sure that your care continues after discharge with a physiotherapist convenient to you.

Walking
You will be up walking with the physiotherapist the day after surgery. Walking is a great exercise. Once out of hospital, try to walk as much as possible – e.g. at least one kilometer twice a day.

Straight leg raises
On the day after surgery you will begin straight leg raises (each leg separately for one minute, up as far as tolerable) twice a day for at least six weeks, or until you get your leg up to 90 degrees to your body. Someone should assist you initially. These leg exercises are to diminish postoperative scarring at the site where the sciatic nerve roots in your back have been operated upon.

Trunk muscle strengthening
A simple exercise can be done anytime and anywhere, before and after surgery. Start four times a day by tightening your abdominal muscles for at least 10 seconds, like straining on the toilet, breathing at the same time. The more you do this the better. Swimming (particularly freestyle) is an excellent exercise, puts little stress on your low back and can start once I am happy that your wound has healed (about 1-2 weeks).

Lumbar spine mobilization (movement)
This is to prevent your entire low back from getting stiff. Your fusion is immediately solid due to the metal work. Back mobilization will be difficult initially because of wound pain and muscle spasm but you will be encouraged to move within the limits of discomfort, commencing as soon as possible after surgery. Twice a day try bending forwards, backwards, right and left sideways, and right and left rotation (twisting), going as far as is comfortable, holding each position for 10 seconds. On the other hand, with everyday activities, you should maintain the principles of low back care, keeping your back vertical and not doing unnecessary lifting, twisting, bending, etc. Initially it will also help if you mobilize in a warm pool (hydrotherapy).

Manipulation
It is arguable if your low back should be manipulated after a fusion, but certainly not until the bone has fully knitted.

Long term outcome
You should gradually get back to all your activities of daily living (dressing, showering, driving, etc). Because a portion of your spine has been operated on and stiffened, patients often describe a fullness at the operation site. You should not expect to return to all of your former activities although this is possible, depending on your demands – e.g. a laborer is unwise to return to former heavy work but a casual golfer could gradually return to golf once the bone has fully knitted. In general, low impact activities are encouraged – e.g. walking as opposed to jogging. The aim of surgery is to get you as comfortable as possible and return your quality of life.

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