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Lang Z, Ge T, Wu J, Yuan Q, Sun Y. Comparison of transfacet and pedicle screws in oblique lateral interbody fusion for single-level degenerative lumbar spine diseases: a retrospective propensity score-matched analysis. BMC Surg 2022; 22:429. [PMID: 36522754 PMCID: PMC9753392 DOI: 10.1186/s12893-022-01880-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To perform a comparative assessment of percutaneous transfacet screws (TFS) and percutaneous bilateral pedicle screws (BPS) in oblique lateral interbody fusion (OLIF) for the treatment of single-level degenerative lumbar spine diseases in terms of radiological examinations and clinical outcomes. METHODS Sixty-six patients who received single-level OLIF with percutaneous supplementary fixation assisted by the robot for the treatment of degenerative lumbar spine diseases were selected. There were 16 cases of OLIF with TFS and 50 cases of OLIF with BPS. The propensity score matching method selected 11 patients in each group with matched characteristics to perform a clinical comparison. RESULTS The estimated blood loss was 68.2 ± 25.2 ml in the OLIF with TFS group compared to 113.6 ± 39.3 ml in the OLIF with BPS group (P < 0.05). The intervertebral disc height raised from 8.6 to 12.9 mm in the TFS group and from 8.9 to 13.9 mm in the BPS group in the immediate postoperative period, and dropped to 10.8 and 12.9 mm at the twelfth month, respectively (P < 0.05). The fusion rates were 91% and 100% for TFS and BPS groups (P > 0.05). Quantitative assessments of back/leg pain of the two groups reached a healthy level in the late period of the follow-up. CONCLUSION Both TFS and BPS techniques for the OLIF surgery relieve back pain caused by degenerative lumbar spine diseases. The TFS technique exhibits less blood loss compared with the BPS. A moderate cage subsidence is present in TFS but no complication is reported.
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Affiliation(s)
- Zhao Lang
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035 People’s Republic of China
| | - Tenghui Ge
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035 People’s Republic of China
| | - Jingye Wu
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035 People’s Republic of China
| | - Qiang Yuan
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035 People’s Republic of China
| | - Yuqing Sun
- grid.414360.40000 0004 0605 7104Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035 People’s Republic of China
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Rosinski AA, Mittal A, Odeh K, Ungurean V, Leasure J, Telles C, Kondrashov D. Alternatives to Traditional Pedicle Screws for Posterior Fixation of the Degenerative Lumbar Spine. JBJS Rev 2021; 9:01874474-202107000-00016. [PMID: 34319968 DOI: 10.2106/jbjs.rvw.20.00177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Traditional pedicle screws are currently the gold standard to achieve stable 3-column fixation of the degenerative lumbar spine. However, there are cases in which pedicle screw fixation may not be ideal. Due to their starting point lateral to the pars interarticularis, pedicle screws require a relatively wide dissection along with a medialized trajectory directed toward the centrally located neural elements and prevertebral vasculature. In addition, low bone mineral density remains a major risk factor for pedicle screw loosening, pullout, and pseudarthrosis. The purpose of this article is to review the indications, advantages, disadvantages, and complications associated with posterior fixation techniques of the degenerative lumbar spine beyond the traditional pedicle screws. METHODS Comprehensive literature searches of the PubMed, Scopus, and Web of Science databases were performed for 5 methods of posterior spinal fixation, including (1) cortical bone trajectory (CBT) screws, (2) transfacet screws, (3) translaminar screws, (4) spinous process plates, and (5) fusion mass screws and hooks. Articles that had been published between January 1, 1990, and January 1, 2020, were considered. Non-English-language articles and studies involving fixation of the cervical or thoracic spine were excluded from our review. RESULTS After reviewing over 1,700 articles pertaining to CBT and non-pedicular fixation techniques, a total of 284 articles met our inclusion criteria. CBT and transfacet screws require less-extensive exposure and paraspinal muscle dissection compared with traditional pedicle screws and may therefore reduce blood loss, postoperative pain, and length of hospital stay. In addition, several methods of non-pedicular fixation such as translaminar and fusion mass screws have trajectories that are directed away from or posterior to the spinal canal, potentially decreasing the risk of neurologic injury. CBT, transfacet, and fusion mass screws can also be used as salvage techniques when traditional pedicle screw constructs fail. CONCLUSIONS CBT and non-pedicular fixation may be preferred in certain lumbar degenerative cases, particularly among patients with osteoporosis. Limitations of non-pedicular techniques include their reliance on intact posterior elements and the lack of 3-column fixation of the spine. As a result, transfacet and translaminar screws are infrequently used as the primary method of fixation. CBT, transfacet, and translaminar screws are effective in augmenting interbody fixation and have been shown to significantly improve fusion rates and clinical outcomes compared with stand-alone anterior lumbar interbody fusion. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alexander A Rosinski
- San Francisco Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, California
| | - Ashish Mittal
- San Francisco Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, California
| | - Khalid Odeh
- San Francisco Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, California
| | | | | | | | - Dimitriy Kondrashov
- San Francisco Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, California
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Bochicchio M, Aicale R, Romeo R, Nardi PV, Maffulli N. Mini-invasive bilateral transfacet screw fixation with reconstruction of the neural arch for lumbar stenosis: A two centre case series. Surgeon 2021; 20:e122-e128. [PMID: 34187737 DOI: 10.1016/j.surge.2021.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/17/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE Lumbar stenosis and instability frequently coexist. Spinal canal decompression is often combined with fixation of the relevant vertebral segment and can be performed using different techniques and devices, including pedicle screws and interspinous devices and facet screws. The present study evaluates the clinical outcome of laminectomy and single-level fusion using a minimally invasive technique for rigid posterior spinal column fixation with two cross-linked lag screws. METHODS The records of patients operated from 2012 to 2016 were retrieved from the computerised medical record database system. Data on age, sex, surgical level, type of deficit and disease were collected. The Oswestry Disability Index (ODI) and Short Form-36 (SF-36) questionnaires were administered pre-operatively and at 1, 6, 12 and 24 months after surgery. MAIN FINDINGS A total of 46 consecutive patients were operated between January 2012 to October 2016. One intraoperative complication was reported, and 4 patients experienced radiographic pseudarthrosis postoperatively. Five patients underwent additional surgery. The lumbar and lower limb VAS score, ODI and SF-36 scores showed statistically significant improvement for each score at the first and last follow-up (p < 0.01). CONCLUSION Percutaneous lumbar transfacet screw placement with the Facet-Link ® system is feasible and safe but with a relatively high rate of poor articular fusion. This technique can reduce the morbidity of single-level lumbar spinal stenosis and mild instability and improve patient outcome scores. Comparative studies, including randomised controlled trials, are needed to confirm these findings.
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Affiliation(s)
- Michele Bochicchio
- Department of Orthopaedic and Trauma Surgery, Casa di Cura di Bernardini, 74121 Taranto, Italy.
| | - Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy; Clinica Ortopedica, San Giovanni di Dio e Ruggi D'Aragona Hospital, 84131 Salerno, Italy.
| | - Rocco Romeo
- Department of Orthopaedic and Trauma Surgery, Ospedale San Carlo, Via Potito Petrone, 85100 Potenza, PZ, Italy.
| | - Pier Vittorio Nardi
- Ospedale Cristo Re, U.O.C. Neurochirurgia, Via delle Calasanziane, 25, 00167, Rome, Italy.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy; Clinica Ortopedica, San Giovanni di Dio e Ruggi D'Aragona Hospital, 84131 Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England; School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England.
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Reid PC, Morr S, Kaiser MG. State of the union: a review of lumbar fusion indications and techniques for degenerative spine disease. J Neurosurg Spine 2019; 31:1-14. [PMID: 31261133 DOI: 10.3171/2019.4.spine18915] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/03/2019] [Indexed: 12/26/2022]
Abstract
Lumbar fusion is an accepted and effective technique for the treatment of lumbar degenerative disease. The practice has evolved continually since Albee and Hibbs independently reported the first cases in 1913, and advancements in both technique and patient selection continue through the present day. Clinical and radiological indications for surgery have been tested in trials, and other diagnostic modalities have developed and been studied. Fusion practices have also advanced; instrumentation, surgical approaches, biologics, and more recently, operative planning, have undergone stark changes at a seemingly increasing pace over the last decade. As the general population ages, treatment of degenerative lumbar disease will become a more prevalent-and costlier-issue for surgeons as well as the healthcare system overall. This review will cover the evolution of indications and techniques for fusion in degenerative lumbar disease, with emphasis on the evidence for current practices.
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Wu JY, Yuan Q, Liu YJ, Sun YQ, Zhang Y, Tian W. Robot-assisted Percutaneous Transfacet Screw Fixation Supplementing Oblique Lateral Interbody Fusion Procedure: Accuracy and Safety Evaluation of This Novel Minimally Invasive Technique. Orthop Surg 2019; 11:25-33. [PMID: 30776856 PMCID: PMC6430475 DOI: 10.1111/os.12428] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 12/28/2018] [Indexed: 01/02/2023] Open
Abstract
Objectives Percutaneous transfacet screw fixation (pTSF) is a minimally invasive posterior fixation technique supplementing oblique lateral interbody fusion (OLIF) for lumbar spinal disorders. Accurate screw insertion is difficult to achieve and technically demanding under 2‐D fluoroscopy. Recently developed robot‐assisted spinal surgery demonstrated a high level of accuracy of pedicle screw insertion and a low complication rate. No published study has reported this combination technique. The aim of our study was to evaluate the accuracy and safety properties of the combination of both minimally invasive techniques: robot‐assisted pTSF supplementing the OLIF procedure. Methods This was an experimental and prospective study. Selected consecutive patients with lumbar degenerative disorders received robot‐assisted pTSF supplementing the OLIF procedure using the TianJi Robot system operated by one senior surgeon from March to October 2018. The accuracy of screw insertion and perioperative screw‐related complications were evaluated. Assessment of the accuracy of screw insertion included intraoperative robotic guidance accuracy and incidence of screw encroachments. Intraoperative robotic guidance accuracy referred to translational and angular deviations of screws, which were assessed by comparing the planned and actual screw trajectories guided by the robot on reconstructed images using TianJi Robot Planning Software. Screw encroachments were evaluated on postoperative CT images and classified by a grading system (A, excellent; B, good; C, poor). Screw‐related complications including intraoperative pin skidding, screw malposition and adjustment, together with postoperative neurological symptoms that correlated with screw malposition were recorded. Results Ten patients, with an average age of 60.2 years, were selected and recruited in this study. All cases were degenerative lumbar spinal disorders, out of which there were 6 cases of Meyerding Grade I degenerative spondylolisthesis. Twenty‐four transfacet screws were inserted by robotic assistance. Instrumented levels included nine segments at L4–5 level and three segments at L3–4 level. Two patients had both L4–5 and L3–4 level fixation. The average surgical time was 3.3 h (SD, 0.8 h). The mean blood loss was 90 mL (SD, 32 mL). Intraoperative guidance accuracy showed 1.09 ± 0.17 mm (ranging from 0.75 to 1.22 mm) translational deviation and 2.17° ± 0.39° (ranging from 1.47° to 2.54°) angular deviation. The gradings of screw encroachment were: 17 screws (71%) with Grade A, 6 screws (25%) with Grade B, and 1 screw (4%) with Grade C. Only one pin skidding occurred intraoperatively and revised subsequently. No postoperative neurological complications were found. Conclusion Our preliminary study of robot‐assisted pTSF supplementing the OLIF procedure showed a high level of accuracy for screw insertion and this minimally invasive combination technique was found to be a feasible and safe procedure.
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Affiliation(s)
- Jing-Ye Wu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Qiang Yuan
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Ya-Jun Liu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Yu-Qing Sun
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Yong Zhang
- TINAVI Medical Technologies Co., Ltd, Beijing, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
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Kretzer RM, Molina C, Hu N, Umekoji H, Baaj AA, Serhan H, Cunningham BW. A Comparative Biomechanical Analysis of Stand Alone Versus Facet Screw and Pedicle Screw Augmented Lateral Interbody Arthrodesis: An In Vitro Human Cadaveric Model. Clin Spine Surg 2016; 29:E336-43. [PMID: 27137151 DOI: 10.1097/bsd.0b013e3182868ef9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Cadaveric biomechanical study. OBJECTIVE To investigate the kinematic response of a stand-alone lateral lumbar interbody cage compared with supplemental posterior fixation with either facet or pedicle screws after lateral discectomy. SUMMARY OF BACKGROUND DATA Lateral interbody fusion is a promising minimally invasive fixation technique for lumbar interbody arthrodesis. The biomechanical stability of stand-alone cage placement compared with supplemental posterior fixation with either facet or bilateral pedicle screws remains unclear. METHODS A 6-degree of freedom spine simulator was used to test flexibility in 7 human cadaveric specimens. Flexion-extension, lateral-bending, and axial-rotation were tested in the intact condition, followed by destabilization through a lateral discectomy at L2-L3 and L4-L5. Specimens were then reconstructed at both operative segments in the following sequence: (1) lateral interbody cage placement; (2) either Discovery facet screws or the Viper F2 system using a transfacet-pedicular trajectory randomized to L2-L3 or L4-L5; and (3) removal of facet screw fixation followed by placement of bilateral pedicle screw instrumentation. Acute range of motion (ROM) was quantified and analyzed. RESULTS All 4 reconstruction groups, including stand-alone interbody cage placement, bilateral Discovery facet screws, the Viper F2 system, and bilateral pedicle screw-rod stabilization, resulted in a significant decrease in acute ROM in all loading modes tested (P<0.05). There were no significant differences observed between the 4 instrumentation groups (P>0.05). Although not statistically significant, the Viper F2 system resulted in greatest reduction of acute ROM in both flexion-extension and axial rotation versus all other treatments (P>0.05). CONCLUSIONS Stand-alone interbody cage placement results in a significant reduction in acute ROM at the operative segment in the absence of posterior supplemental fixation. If added fixation is desired, facet screw placement, including the Viper F2 facet screw system using an integrated compression washer and transfacet-pedicular trajectory, provides similar acute stability to the spinal segment compared with traditional bilateral pedicle screw fixation in the setting of lateral interbody cage deployment.
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Affiliation(s)
- Ryan M Kretzer
- *Western Neurosurgery Ltd., An Affiliated Partner of the Carondelet Neurological Institute, St. Joseph's Hospital, Tucson, AZ†The Orthopaedic Spinal Research Laboratory, St. Joseph Medical Center, Towson‡Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD§Division of Neurosurgery, The University of Arizona Medical Center, Tucson, AZ∥DePuy Spine, a Johnson & Johnson Company, Raynham, MA
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Felbaum DR, Lajthia O, Syed HR, Voyadzis JM. Percutaneous Lumbar Transfacet Screw Fixation: A Technique Analysis of 176 Screws in 83 Patients With Assessment of Radiographic Accuracy, Hardware Failure, and Complications. Oper Neurosurg (Hagerstown) 2016; 12:340-349. [DOI: 10.1227/neu.0000000000001356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 04/08/2016] [Indexed: 01/09/2023] Open
Abstract
Supplemental Digital Content Is Available in the Text.
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Affiliation(s)
- Daniel R Felbaum
- Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, DC
| | - Orgest Lajthia
- Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, DC
| | - Hasan R Syed
- Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, DC
| | - Jean Marc Voyadzis
- Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, DC
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Abstract
Pedicle screw fixation is the preferred method of posterior fusion in lumbar spinal surgery. The technique provides three-column support of the vertebrae, contributing to the biomechanical strength of the construct. However, open pedicle screw fixation often necessitates wide posterior exposure and dissection with soft-tissue disruption of the facet joint. Alternative posterior fixation techniques have been developed to reduce surgical time, soft-tissue dissection, disruption of the adjacent facet joint capsule, neurologic risk, and implant cost. Results of these techniques are comparable to those of standard pedicle screw fixation systems. Certain patients, especially those at a lower risk of nonunion or those who require posterior fixation only as an adjunct to anterior column support, may benefit from the shorter surgical time and limited posterior exposure of the alternative techniques. However, the decreased rigidity of these alternative constructs can result in excessive motion, which can lead to nonunion and early hardware failure.
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Husain A, Akpolat YT, Palmer DK, Rios D, Criswell KR, Cheng WK. A comparison of open versus percutaneous cervical transfacet fixation. J Neurosurg Spine 2016; 25:430-435. [PMID: 27176112 DOI: 10.3171/2016.2.spine151334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study is to describe a technique for percutaneous cervical transfacet screw placement and compare this technique to the open technique with regard to the accuracy of facet capture and the potential of placing neurovascular structures at risk. METHODS Eight cadaveric cervical spines were harvested. One side of each spine was assigned to the percutaneous group, and the other side to the open group. The spines were instrumented from C-3 to T-1 (80 screws). The distance to the spinal canal, foramen transversarium, and neural foramen were measured to determine the likelihood of placing neurovascular structures at risk. The percentage of the facet joint captured and the angle of screw trajectory compared with the ideal trajectory were used to determine the accuracy. RESULTS There were, in total, 11 misplacements of screws: 2 screws using the open technique and 9 screws using the percutaneous technique (p = 0.006). From a neurovascular point of view, 3 percutaneous screws violated the foramen transversarium. Two of these percutaneous screws violated the neural foramen. No neurovascular foramina were violated using the open technique. The open technique resulted in a significantly greater distance from the screw to the spinal canal (p < 0.001). The distance from the screw to the foramen transversarium (p = 0.015), as well as the distance from the screw to the neural foramen (p = 0.012), did not demonstrate statistical difference when using either technique. As for the accuracy of facet capture, 8 screws exhibited less than 15% purchase of the facet joint. Six of these screws were placed using the percutaneous technique, and 2 screws were placed using the open technique. CONCLUSIONS There is a higher incidence of screw misplacement using the percutaneous transfacet in comparison to the open transfacet technique. The accuracies of facet capture using the 2 techniques were not statistically different. Surgeons will need to understand the potential risk of using the percutaneous technique as an alternative to open transfacet fixation.
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Affiliation(s)
| | | | - Daniel K Palmer
- Loma Linda University School of Medicine, Loma Linda, California
| | - David Rios
- Loma Linda University School of Medicine, Loma Linda, California
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Biomechanics of posterior instrumentation in L1-L3 lateral interbody fusion: Pedicle screw rod construct vs. transfacet pedicle screws. Clin Biomech (Bristol, Avon) 2016; 31:59-64. [PMID: 26499776 DOI: 10.1016/j.clinbiomech.2015.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/01/2015] [Accepted: 10/05/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of pedicle screws is the gold standard for supplemental posterior fixation in lateral interbody fusion. Information about the performance of transfacet pedicle screws compared to standard pedicle screws and rods in the upper lumbar spine with or without a lateral interbody fusion device in place is limited. METHODS Fifteen fresh frozen human cadaveric lumbar spine segments (T12-L4) were studied using standard pure moment flexibility tests. Specimens were divided into two groups to receive either bilateral transfacet pedicle screws (n=8) or bilateral pedicle screws (n=14). Stability of each motion segment (L1-L2 and L2-L3) was evaluated intact, with posterior instrumentation with an intact disc, with posterior instrumentation and a lateral interbody fusion device in place, and following cyclic loading with the interbody device and posterior instrumentation still in place. Both raw values of motion (range of motion, lax zone and stiff zone) and normalized mobility (ratios to intact) were analyzed for each case. FINDINGS In terms of immediate stability, transfacet pedicle screws performed equivalent to similarly sized pedicle screws, both with intact disc and with lateral interbody fusion device in all directions of loading. Stability following cyclic loading decreased significantly during lateral bending and axial rotation. INTERPRETATION Posterior fixation with transfacet pedicle screws provides equivalent immediate stability to similarly sized pedicle screws. However, in the presence of a lateral interbody fusion device, pedicle screws seem to resist loosening more and may be a better option for fusion in the upper lumbar spine.
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Filippiadis DK, Kelekis A. A review of percutaneous techniques for low back pain and neuralgia: current trends in epidural infiltrations, intervertebral disk and facet joint therapies. Br J Radiol 2015; 89:20150357. [PMID: 26463233 DOI: 10.1259/bjr.20150357] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Low back pain and neuralgia due to spinal pathology are very common symptoms debilitating numerous patients with peak prevalence at ages between 45 and 60 years. Intervertebral discs and facet joints act as pain sources in the vast majority of the cases. Diagnosis is based on the combination of clinical examination and imaging studies. Therapeutic armamentarium for low back pain and neuralgia due to intervertebral discs and/or facet joints includes conservative therapy, injections, percutaneous therapeutic techniques and surgical options. Percutaneous, therapeutic techniques are imaging-guided, minimally invasive treatments which can be performed as outpatient procedures. In cases of facet joint syndrome, they include, apart from injections, neurolysis with radiofrequency/cryoablation, MR-guided high-intensity focused ultrasound and percutaneous fixation techniques. In case of discogenic pain, apart from infiltrations, therapeutic techniques can be classified in to two main categories: decompression (mechanical, thermal, chemical) techniques and biomaterials implantation/disc cell therapies. Strict sterility measures are a prerequisite and should include extensive local sterility and antibiotic prophylaxis. This article will report clinical and imaging findings for each pathology type and the association with treatment decision. In addition, we will describe in detail all possible treatment techniques for low back pain and neuralgia, and we will report recently published results of these techniques summarizing the data concerning safety and effectiveness as well as the level of evidence. Finally, we will try to provide a rational approach for the therapy of low back pain and neuralgia by means of minimally invasive imaging-guided percutaneous techniques.
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Affiliation(s)
| | - Alexis Kelekis
- 2nd Radiology Department, University General Hospital "ATTIKON", Athens, Greece
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Luo P, Chen YH, Wu YS, Dou HC, Chi YL, Lin Y. Comparison of transforaminal lumbar interbody fusion performed with unilateral pedicle screw fixation or unilateral pedicle screw-contralateral percutaneous transfacet screw fixation. Br J Neurosurg 2015; 30:86-90. [PMID: 26313404 DOI: 10.3109/02688697.2015.1071324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To determine whether unilateral pedicle screw fixation is comparable with unilateral pedicle screw and contralateral percutaneous transfacet screw fixation in single-level lumbar spinal fusion. METHODS Fifty-eight patients were divided into either unilateral (n = 32) or unilateral pedicle screw and contralateral percutaneous transfacet screw fixation (n = 26) instrumentation groups. The operating time, blood loss, length of hospital stay, clinical outcomes, total lumbar scoliotic changes, and fusion and complication rates were compared between the two groups. RESULTS There were no significant differences between the two groups in blood loss, length of hospital stay, clinical results, total lumbar scoliotic changes, and fusion and complication rates. There were significant differences in duration of operating time between 2 groups. CONCLUSIONS Unilateral pedicle screw fixation may be as effective as unilateral PS with contralateral percutaneous transfacet screw fixation for the treatment of lumbar degenerative disorders.
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Affiliation(s)
- Peng Luo
- a Department of orthopedic Surgery , The Second Affiliated Hospital of Wenzhou Medical University
| | - Yi-Heng Chen
- a Department of orthopedic Surgery , The Second Affiliated Hospital of Wenzhou Medical University
| | - Yao-Sen Wu
- a Department of orthopedic Surgery , The Second Affiliated Hospital of Wenzhou Medical University
| | - Hai-Cheng Dou
- a Department of orthopedic Surgery , The Second Affiliated Hospital of Wenzhou Medical University
| | - Yong-Long Chi
- a Department of orthopedic Surgery , The Second Affiliated Hospital of Wenzhou Medical University
| | - Yan Lin
- a Department of orthopedic Surgery , The Second Affiliated Hospital of Wenzhou Medical University
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Rhee JW, Petteys RJ, Anaizi AN, Sandhu FA, Voyadzis JM. Prospective evaluation of 1-year outcomes in single-level percutaneous lumbar transfacet screw fixation in the lateral decubitus position following lateral transpsoas interbody fusion. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:2546-54. [PMID: 25893335 DOI: 10.1007/s00586-015-3934-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 04/04/2015] [Accepted: 04/05/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE Lateral transpsoas lumbar interbody fusion (LTIF) is an accepted treatment for degenerative lumbar disc disease. Bilateral percutaneous transfacet (TF) fixation is a promising option for stabilization following LTIF. Here, we describe our experience with this technique and assess the clinical outcomes and efficacy. METHODS Thirty-eight consecutive patients were identified who underwent LTIF followed by bilateral percutaneous transfacet fixation in the lateral position. Preoperative and 1-year postoperative VAS scores, and operative data were prospectively recorded. One-year outcomes were also assessed according to the MacNab criteria. Fusion was assessed at 1 year via computed tomography and dynamic radiography. Two-tailed Student's t test was used to compare VAS scores. RESULTS Twenty-six patients underwent fusion at L4-5, 11 at L3-4, and one at L2-3; two patients were lost to follow-up. Mean operative time was 148.0 ± 47.9 min; mean blood loss was 33.0 ± 26.1 ml; mean hospital stay was 53.5 ± 51.2 h. Mean preoperative VAS scores for back and leg pain were 7.4 ± 3.0 and 7.0 ± 2.9, respectively; mean postoperative VAS scores for back and leg pain were 1.9 ± 2.4 (p < 0.0001) and 2.0 ± 3.0 (p < 0.0001), respectively. Most (89 %) patients had some relief, 72 % good to excellent and 17 % fair outcomes; eleven percent had little to no relief. There was one postoperative complication (pulmonary embolus). All patients had evidence of solid bony fusion. CONCLUSIONS Percutaneous transfacet fixation in the lateral position is a safe and effective alternative for fixation after LTIF and may be associated with shorter operative time and less blood loss than other posterior fixation techniques.
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Affiliation(s)
- Jay W Rhee
- Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Road, NW, PHC-7, Washington, DC, 20007, USA
| | - Rory J Petteys
- Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Road, NW, PHC-7, Washington, DC, 20007, USA.
| | - Amjad N Anaizi
- Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Road, NW, PHC-7, Washington, DC, 20007, USA
| | - Faheem A Sandhu
- Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Road, NW, PHC-7, Washington, DC, 20007, USA
| | - Jean-Marc Voyadzis
- Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Road, NW, PHC-7, Washington, DC, 20007, USA.
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Satoskar SR, Goel AA, Mehta PH, Goel A. Quantitative morphometric analysis of the lumbar vertebral facets and evaluation of feasibility of lumbar spinal nerve root and spinal canal decompression using the Goel intraarticular facetal spacer distraction technique: A lumbar/cervical facet comparison. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2015; 5:157-62. [PMID: 25558146 PMCID: PMC4279278 DOI: 10.4103/0974-8237.147079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objective: The authors evaluate the anatomic subtleties of lumbar facets and assess the feasibility and effectiveness of use of ‘Goel facet spacer’ in the treatment of degenerative spinal canal stenosis. Materials and Methods: Twenty-five lumbar vertebral cadaveric dried bones were used for the purpose. A number of morphometric parameters were evaluated both before and after the introduction of Goel facet spacers within the confines of the facet joint. Results: The spacers achieved distraction of facets that was more pronounced in the vertical perspective. Introduction of spacers on both sides resulted in an increase in the intervertebral foraminal height and a circumferential increase in the spinal canal dimensions. Additionally, there was an increase in the disc space or intervertebral body height. The lumbar facets are more vertically and anteroposteriorly oriented when compared to cervical facets that are obliquely and transversely oriented. Conclusions: Understanding the anatomical peculiarities of the lumbar and cervical facets can lead to an optimum utilization of the potential of Goel facet distraction arthrodesis technique in the treatment of spinal degenerative canal stenosis.
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Affiliation(s)
- Savni R Satoskar
- Department of Neurosurgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, India
| | - Aimee A Goel
- Medical Student, University College London, United Kingdom
| | - Pooja H Mehta
- Intern, Dnyandeo Yashwantrao Patil Medical College, Nerul, Navi Mumbai, Maharashtra, India
| | - Atul Goel
- Department of Neurosurgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, India
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15
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Manfré L. CT-Guided Transfacet Pedicle Screw Fixation in Facet Joint Syndrome: A Novel Approach. Interv Neuroradiol 2014; 20:614-20. [PMID: 25363265 DOI: 10.15274/inr-2014-10031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 01/12/2014] [Indexed: 02/03/2023] Open
Abstract
Axial microinstability secondary to disc degeneration and consequent chronic facet joint syndrome (CFJS) is a well-known pathological entity, usually responsible for low back pain (LBP). Although posterior lumbar fixation (PIF) has been widely used for lumbar spine instability and LBP, complications related to wrong screw introduction, perineural scars and extensive muscle dissection leading to muscle dysfunction have been described. Radiofrequency ablation (RFA) of facet joints zygapophyseal nerves conventionally used for pain treatment fails in approximately 21% of patients. We investigated a "covert-surgery" minimal invasive technique to treat local spinal instability and LBP, using a novel fully CT-guided approach in patients with axial instability complicated by CFJS resistant to radioablation, by introducing direct fully or partially threaded transfacet screws (transfacet fixation - TFF), to acquire solid arthrodesis, reducing instability and LBP. The CT-guided procedure was well tolerated by all patients in simple analogue sedation, and mean operative time was approximately 45 minutes. All eight patients treated underwent clinical and CT study follow-up at two months, revealing LBP disappearance in six patients, and a significant reduction of lumbar pain in two. In conclusion, CT-guided TFF is a fast and safe technique when facet posterior fixation is needed.
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Affiliation(s)
- Luigi Manfré
- Minimal Invasive Spine Therapy, Department of Neuroradiology, Cannizzaro Emergency Hospital; Catania, Italy -
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16
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Hartensuer R, Riesenbeck O, Schulze M, Gehweiler D, Raschke MJ, Pavlov PW, Vordemvenne T. Biomechanical evaluation of the Facet Wedge: a refined technique for facet fixation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:2321-9. [PMID: 25155837 DOI: 10.1007/s00586-014-3533-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 08/20/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Purpose of this paper is to evaluate the primary stability of a new approach for facet fixation the so-called Facet Wedge (FW) in comparison with established posterior fixation techniques like pedicle screws (PS) and translaminar facet screws (TLS) with and without anterior cage interposition. METHODS Twenty-four monosegmental fresh frozen non-osteoporotic human motion segments (L2-L3 and L4-L5) were tested in a two-arm biomechanical study using a robot-based spine tester. Facet Wedge was compared with pedicle screws and translaminar screws as a stand-alone device and in combination with an anterior fusion cage. RESULTS Pedicle screws, FW and translaminar screws could stabilize an intact motion segment effectively. Facet Wedge was comparable to PS for lateral bending, extension and flexion and slightly superior for axial rotation. Facet Wedge showed a superior kinematic capacity compared to translaminar screws. CONCLUSIONS Facet Wedge offers a novel posterior approach in achieving primary stability in lumbar spinal fixation. The results of the present study showed that the Facet Wedge has a comparable primary stability to pedicle screws and potential advantages over translaminar screws.
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Affiliation(s)
- René Hartensuer
- Department of Trauma-, Hand- and Reconstructive Surgery, Wilhelms-University of Muenster, Albert-Schweitzer-Campus 1, W1, 48149, Münster, Germany,
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17
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Awad BI, Lubelski D, Shin JH, Carmody MA, Hoh DJ, Mroz TE, Steinmetz MP. Bilateral Pedicle Screw Fixation versus Unilateral Pedicle and Contralateral Facet Screws for Minimally Invasive Transforaminal Lumbar Interbody Fusion: Clinical Outcomes and Cost Analysis. Global Spine J 2013; 3:225-30. [PMID: 24436873 PMCID: PMC3854596 DOI: 10.1055/s-0033-1349399] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 05/31/2013] [Indexed: 01/04/2023] Open
Abstract
Study Design Retrospective clinical study. Objectives Recent biomechanical studies have shown no differences in stiffness or range of motion following minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) between unilateral pedicle and contralateral facet screw (UPFS) and bilateral pedicle screw (BPS) constructs. No studies have compared these two constructs based upon clinical outcomes. Methods Twenty-six consecutive patients who had single-level MIS TLIF were retrospectively reviewed. Outcome measures collected for patients with BPS were compared with those with UPFS. Results No associations were found between construct and length of stay (p = 0.5), operative time (p = 0.2), or Odom's criteria (p = 0.7); 79% of patients in the UPFS group as compared with 71.5% in the BPS group had good or excellent outcomes. Mean follow-up was 17.7 months for the UPFS group and 20.2 months for the BPS group. There was one complication in each group, including a seroma in the BPS group and a revision operation in the UPFS group. Implant costs for the BPS group were 35% greater than the UPFS group. Conclusions The present study is the first to demonstrate that patients undergoing MIS TLIF with BPS as compared with UPFS for single-level degenerative lumbar disease had similar clinical outcomes.
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Affiliation(s)
- Basem I. Awad
- Department of Neurosciences, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States,Department of Neurosurgery, Mansoura University School of Medicine, Mansoura, Egypt,Address for correspondence Basem I. Awad, MD Department of Neurosciences, MetroHealth Medical Center, Case Western Reserve University2500 MetroHealth Drive, Cleveland, OH 44109United States
| | - Daniel Lubelski
- Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, United States
| | - John H. Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard School of Medicine, Boston, Massachusetts, United States
| | - Margaret A. Carmody
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Daniel J. Hoh
- Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
| | - Thomas E. Mroz
- Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, United States
| | - Michael P. Steinmetz
- Department of Neurosciences, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States
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Minimally Invasive Lumbar Transfacet Screw Fixation in the Lateral Decubitus Position After Extreme Lateral Interbody Fusion. ACTA ACUST UNITED AC 2013; 26:98-106. [DOI: 10.1097/bsd.0b013e318241f6c3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bykowski JL, Wong WHW. Role of facet joints in spine pain and image-guided treatment: a review. AJNR Am J Neuroradiol 2012; 33:1419-26. [PMID: 21940805 PMCID: PMC7966535 DOI: 10.3174/ajnr.a2696] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Chronic low back and neck pain remain prevalent medical concerns, with much debate regarding the effective evaluation and treatment. Facet disease has been implicated as a source of axial nonradiating low back pain. We discuss patient evaluation, the role of imaging, current and emerging image-guided therapies for facet-related pain, and the increasing importance of outcome-related research in this arena.
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Affiliation(s)
- J L Bykowski
- Department of Radiology, UCSD Medical Center, San Diego, CA, USA.
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