Introduction: Facet bone dowels have been introduced and marketed as a less invasive alternative to established fixation methods in performing spinal fusions. Surgeons have been placing them during lumbar laminectomies and billing for fusion. These bone dowels have also been placed percutaneously in outpatient centers and pain clinics for facet-mediated back pain.

Methods: 149 consecutive patients had facet bone dowel placement. Fusion rates were determined by postoperative CT scans and dynamic lumbar XRays if CT was not available. Surgical indications for placement of the bone dowels to achieve fusion included synovial cyst, lumbar stenosis and lumbar stenosis with grade 1 spondylolisthesis. The bone dowels were placed after open exploration of the facet complex or percutaneously on the contralateral side.

Results: 149 patients comprise the entire cohort from April2008 through May2011. 53 patients were classified as “indeterminate” fusion due to the only follow up imaging occurring less than 6 months postoperatively. Of the remaining 96 patients, 6 (6/96=6.3%) had a fusion seen on CT and 2 more did not exhibit any movement on dynamic lumbar XRays for a total fusion rate of 8.3% (8/96). 88 (91.7%) patients were shown on imaging to not have a solid fusion either by visualizing a patent facet joint on CT or measurable movement between the flexion and extension lumbar XRays. 7 of the 8 patients who fused did undergo intraoperative arthrodesis techniques beyond those required by the company representatives.

Conclusions: The work required to place facet bone dowels does not equal the time, risk and skill of performing a spinal arthrodesis. Fusions significantly increase the cost of lumbar surgery. Therefore, consideration should be given to not allowing surgeons or interventionalists to bill for fusions after placement of facet bone dowels without properly documenting the work necessary to perform a bony arthrodesis.

Patient Care: Decrease overall health care costs by highlighting an expensive procedure that may not be as efficacious as advertised.

Learning Objectives: By the conclusion of this session, participants should be able to 1) appreciate that the implantation of facet bone dowels does not constitute performing a fusion, 2) question the efficacy of purely percutaneous spinal fusion techniques

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