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Facetectomy is a surgical procedure of the spine. The aim is to remove excess bony deposits on the facets of the vertebrae in order to reduce pressure on the spinal nerves.
This procedure is best performed by a specialist veterinary orthopedic surgeon at a referral center. Facetectomy is rarely performed in cats, and when it is required it is often one of several procedures performed during the same operation in order to relieve pressure on the spinal cord and reduce pain .
Facetectomy is considered a surgery of last resort, and undertaken if the cat is in severe pain or suffering paralysis due to pressure on the nerves that fails to respond to medical therapy.
The patient is carefully assessed using MRI and CT scans, to ensure that surgery is the best option. A full general anesthetic is administered, the fur clipped from the area over the spine, and the skin aseptically prepared for surgery.
The surgeon makes a long incision parallel to the spine and dissects down the the relevant vertebrae. The facets are small articular surfaces projecting from the body of the vertebrae. The excess bone is debrided away, most commonly using a surgical burr.
Other procedures may be performed at the same time, such as laminectomy, foraminotomy, and discectomy. These refer to debriding away bone or disc material form various anatomical landmarks on the vertebra.
When the surgery is complete the skin incision is sutured and the cat woken from the anesthetic.
Facetectomy is a highly skilled procedure and success depends in part on the experience of the surgeon. However, it should also be remembered that facetectomy is often performed as a salvage procedure and the cat may already have neurological deficits. It cannot be guaranteed that surgery, even at the hands of the best surgeons, will procure a return to function for the cat.
However, when facetectomy is successful the patient suffers less pain and may with time become more mobile as a result.
In the immediate postoperative period, the cat must not interfere with the skin incision. This means wearing a cone or a bodysuit in order to protect the sutures.
Rest is also critical in order to minimize swelling at the operation site, which could put pressure on the nerves. Also, in the first few weeks post surgery, the spine needs treating with care, as fibrous tissue needs to form and stabilize the back. Thus, the patient may need to be restricted to a cage or small room.
If the cat has poor mobility, then nursing care is needed such as managing a urinary catheter and assisting the patient to pass feces.
The cost of a specialist consultation is often in the region of $300 to $400. An MRI scan prior to surgery is likely to be a minimum of $1,200. The cost of the surgical procedure is around $3,000 to $5,000 and there could well be intensive care nursing charges for a period of days or weeks afterwards. Considering all the factors involved, the cost of a facetectomy could range from $7,000 to $10,000.
Facetectomy is not without risk. When all goes well the benefits include a paralysed cat regaining mobility or a significant reduction in the patient's pain. However, this is spinal surgery and the risks involve accidental damage to the spinal cords or nerves, which in a worst case scenario could result in permanent paralysis leading to euthanasia.
Cats born with congenital malformations of the spine should not be bred from, as they may pass the genes for their disorder down to their offspring.
Another indication for surgery are cats involved in a road traffic accident. This can be prevented by supervising the cat whilst outdoors and keeping them on a harness, or keeping the cat indoors.
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