Massoud-Goel Method for Percutaneous Trans-Facet Fixation Under Local Anesthesia in the Treatment of Degenerative Spine Conditions: Theory, Technique, and Clinical Outcomes

Abstract Background: Degenerative spinal instability is a major cause of radiculopathy and myelopathy. Conventional decompression may not address the primary pathology—vertical spinal instability. The Massoud-Goel technique employs percutaneous trans-facet fixation (PTF) to stabilize affected segments while minimizing soft tissue disruption. Objective: To evaluate clinical and radiological outcomes of PTF using the Massoud-Goel technique in degenerative lumbar, subaxial cervical, and atlantoaxial instability. Methods: A prospective study was conducted over 3 years on 150 patients (88 males, 62 females; mean age 37.8 ± 8.4 years) with symptomatic degenerative spinal disease unresponsive to conservative therapy. PTF was performed under local or general anesthesia. Primary outcomes included pain reduction (VAS) and spinal stability (CT-confirmed fusion). Secondary outcomes were functional improvement (ODI), complication rates, hospital stay, and satisfaction. Results: Mean VAS scores improved from 7.8 ± 1.1 preoperatively to 1.5 ± 0.8 at 36 months (80.8% reduction). ODI improved from 52.6 ± 9.3 to 12.7 ± 4.2 (75.8% improvement). Fusion was achieved in 98.1% of cases. Complications occurred in 10.7% (infection 3.3%, transient radiculopathy 4.7%, screw malposition 2.7%). Mean hospital stay was 1.6 ± 1.1 days; 87.3% discharged within 24 hours. Overall satisfaction was high (very satisfied: 74.6%). Conclusion: Percutaneous trans-facet fixation via the Massoud-Goel technique is a safe, minimally invasive, and effective alternative for degenerative spinal instability, achieving excellent pain relief, fusion, and functional recovery with low morbidity. Further long-term evaluation is recommended. Keywords: Degenerative spine, Percutaneous trans-facet fixation, Spinal instability, Local anesthesia, Massoud-Goel technique