Targeted facet joint surface remodeling for lumbar facet syndrome: A retrospective case series.

BACKGROUND: Lumbar facet joint syndrome is a common cause of chronic axial low back pain. Current interventional treatments such as medial branch radiofrequency denervation may provide temporary relief, with frequent symptom recurrence. Direct surgical treatment of the facet joint surface itself has rarely been reported. OBJECTIVE: To evaluate the clinical outcomes of targeted facet joint surface remodeling in patients with lumbar facet joint syndrome. MATERIALS AND METHODS: This retrospective monocentric case series included 32 patients treated between January 2022 and March 2025. All patients presented with chronic axial low back pain and a positive response to diagnostic facet joint injection. The surgical procedure consisted of targeted facet joint surface shaving and selective osteophyte removal, performed through an open or endoscopic approach, without decompression or fusion. Pain and functional outcomes were assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) preoperatively, and at 1, 3, 6, and 9 months postoperatively. RESULTS: The cohort included 18 women and 14 men, with ages ranging from 39 to 69 years. Mean preoperative VAS was 7.34 and improved to 4.12 at 1 month, 3.99 at 3 months, 3.95 at 6 months, and 3.92 at 9 months postoperatively. Mean ODI decreased from 39 preoperatively to 24 at 1 month, 21 at 3 months, 20 at 6 months, and 19 at 9 months. No intraoperative or postoperative complications were observed. CONCLUSION: Targeted facet joint surface remodeling appears to be a safe and effective motion-preserving surgical option for carefully selected patients with lumbar facet joint syndrome. This proof-of-concept study demonstrates encouraging short-to mid-term clinical outcomes and supports further prospective evaluation.