Clinical Outcomes of Lumbar Facet Arthroplasty for Degenerative Lumbar Disease: A Systematic Review and Meta-Analysis of Predominantly Total Posterior Spine System Evidence.

Background

Lumbar facet joint arthroplasty has emerged as a motion-preserving alternative to fusion for the treatment of degenerative lumbar spine diseases. While early studies have reported promising outcomes, the overall clinical efficacy, durability, and safety profile remain incompletely defined.

Objective

To systematically evaluate the clinical, radiographic, and perioperative outcomes of lumbar facet arthroplasty in patients with degenerative lumbar disease.

Methods

A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. PubMed, Embase, Web of Science, and Scopus were searched through November 2025. Eligible studies included clinical investigations of posterior lumbar facet arthroplasty in degenerative conditions with a minimum sample size of 10 patients. Outcomes of interest included reoperation rates, patient-reported outcomes (visual analog scale [VAS], Oswestry Disability Index [ODI]), range of motion (ROM), and perioperative parameters. Random-effects meta-analysis was performed, and heterogeneity was assessed using I² statistics. Risk of bias was evaluated using the Joanna Briggs Institute's critical appraisal tools.

Results

A total of 13 reports were included, 11 of which supplied data for outcome-specific meta-analyses. The conversion to fusion or arthroplasty removal was 6% and 7%, respectively. Final leg and back VAS scores were 1.10 and 1.72, with mean changes of -6.36 and -5.36, respectively; the final ODI was 17.30 (Δ -37.52), and ROM was 6.40° (Δ -0.21°). The mean blood loss and operating time were 391.74 mL and 186.72 minutes. Adjacent-segment reoperation was observed in 0/206 arthroplasty and 5/93 fusion patients in 1 randomized Total Posterior Spine System (TOPS) comparison. Most outcomes were highly heterogeneous.

Conclusions

Available evidence-predominantly for TOPS-suggests improvement in pain and disability with preservation of segmental motion. There was a high degree of heterogeneity; however, scanty comparative evidence and differences in follow-up make it difficult to draw conclusions and generalizations from the data across devices. CLINICAL RELEVANCE Lumbar facet arthroplasty may improve pain and disability while preserving motion in selected patients. Evidence is predominantly TOPS-based, and long-term durability and superiority to fusion remain uncertain. LEVEL OF EVIDENCE: 4