Do facet screws provide the required stability in lumbar fixation? A biomechanical comparison of the Boucher technique and pedicular fixation in primary and circumferential fusions

Agarwala, Amit; Bucklen, Brandon; Muzumdar, Aditya; Moldavsky, Mark; Khalil, Saif

doi:10.1016/j.clinbiomech.2011.07.007

Cited by 29 publications

(12 citation statements)

References 13 publications

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“…39,57,89,103,150,164 When posterior fixation was placed as a standalone construct without anterior column fixation, PSs were noted to be superior to TFSs in axial rotation and lateral bending, but no difference was noted in flexion and extension. 4 Unfortunately, the TFS may be limited based on orientation of the facet and an overly vertical facet orientation, which is more common in higher lumbar levels such as L1 and L2, and may make this technique difficult. 136 Bilateral TFS clinical use has not been reported to date.…”

Section: Transfacet Screw Fixationmentioning

confidence: 99%

State of the union: a review of lumbar fusion indications and techniques for degenerative spine disease

Reid¹,

Morr²,

Kaiser³

2019

Journal of Neurosurgery: Spine

119

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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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Section: Transfacet Screw Fixationmentioning

confidence: 99%

State of the union: a review of lumbar fusion indications and techniques for degenerative spine disease

Reid¹,

Morr²,

Kaiser³

2019

Journal of Neurosurgery: Spine

119

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“…The material properties of different tissues were cited from the previous reported literature (Table). 5,[14][15][16][17][18][19][20][21][22][23]…”

Section: Construction and Validation Of An Intact Finite Element Modelmentioning

confidence: 99%

Finite Element Analysis of 3 Posterior Fixation Techniques in the Lumbar Spine

Gong¹,

Chen²,

Zhu³

et al. 2014

Orthopedics

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This study compared the biomechanics of 3 fixation techniques: bilateral pedicle screw (BPS) fixation, unilateral pedicle screw (UPS) fixation, and UPS supplemented with translaminar facet screw (UPS+TLFS) fixation. The study was conducted in an L3-L5 finite element model. Three different finite element models were created by adopting different fixation techniques after removal of the left L3-L4 and L4-L5 facet joints. A 500-N compressive preload combined with 8-NM moment were applied in 3 finite element models with 3 fixation techniques during different movements. Angular displacement and stress distribution were recorded. As described in this article, the UPS model had the most variation in angular displacement, the BPS model was intermediate, and the UPS+TLFS model had the least mobility. Most of the stress accumulated on the body and tail of the pedicle screws and the connecting rods in the UPS and BPS models, but stress accumulated on the rods and the part of the facet joint pierced by the TLFS in the UPS+TLFS model. The middle part of the pedicle screw endured little stress compared with the upper and lower parts. The maximum stress on the fixation devices was highest in the UPS model. The maximum stress in the UPS+TLFS model was the lowest among the 3 models. Biomechanically, UPS+TLFS fixation is superior to either UPS fixation or BPS fixation in improving stability and reducing stress. Bilateral pedicle screw fixation is intermediate, and UPS fixation is inferior.

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“…This method has been advocated as an alternative to lateral mass screw/rod fixation in the cervical spine 2,3,11,20 and pedicle screw fixation in the lumbar spine. 1,21 Transfacet screws have an inherent mechanical advantage over lateral mass trajectories in that they obtain purchase in 4 cortices, and it has been reported that transfacet screws provide greater pullout strength than cervical lateral mass fixation.…”

mentioning

confidence: 99%

Kinetic analysis of anterior cervical discectomy and fusion supplemented with transarticular facet screws

Traynelis

Sherman²,

Nottmeier

et al. 2014

SPI

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Object The clinical success rates of anterior cervical discectomy and fusion (ACDF) procedures are substantially reduced as more cervical levels are included in the fusion procedure. One method that has been proposed as an adjunctive technique for multilevel ACDF is the placement of screws across the facet joints (“transfacet screws”). However, the biomechanical stability imparted by transfacet screw placement (either unilaterally or bilaterally) has not been reported. Therefore, the purpose of this study was to determine the acute stability conferred by implementation of unilateral and bilateral transfacet screws to an ACDF construct. Methods Eight C2–T1 fresh-frozen human cadaveric spines (3 female and 5 male; mean age 50 years) were tested. Three different instrumentation variants were performed on cadaveric cervical spines across C4–7: 1) ACDF with an intervertebral spacer and standard plate/screw instrumentation; 2) ACDF with an intervertebral spacer and standard plate/screw instrumentation with unilateral facet screw placement; and 3) ACDF with an intervertebral spacer and standard plate/screw instrumentation with bilateral facet screw placement. Kinetic ranges of motion in flexion-extension, lateral bending, and axial rotation at 1.5 Nm were captured after each of these procedures and were statistically analyzed for significance. Results All 3 fixation scenarios produced statistically significant reductions (p < 0.05) in all 3 bending planes compared with the intact condition. The addition of a unilateral facet screw to the ACDF construct produced significant reductions at the C4–5 and C6–7 levels in lateral bending and axial rotation but not in flexion-extension motion. Bilateral facet screw fixation did not produce any statistically significant decreases in flexion-extension motion compared with unilateral facet screw fixation. However, in lateral bending, significant reductions at the C4–5 and C5–6 levels were observed with the addition of a second facet screw. The untreated, adjacent levels (C2–3, C3–4, and C7–1) did not demonstrate significant differences in range of motion. Conclusions The data demonstrated that adjunctive unilateral facet screw fixation to an ACDF construct provides significant gains in stability and should be considered a potential option for increasing the likelihood for obtaining a successful arthrodesis for multilevel ACDF procedures.

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Do facet screws provide the required stability in lumbar fixation? A biomechanical comparison of the Boucher technique and pedicular fixation in primary and circumferential fusions

Cited by 29 publications

References 13 publications

State of the union: a review of lumbar fusion indications and techniques for degenerative spine disease

State of the union: a review of lumbar fusion indications and techniques for degenerative spine disease

Finite Element Analysis of 3 Posterior Fixation Techniques in the Lumbar Spine

Kinetic analysis of anterior cervical discectomy and fusion supplemented with transarticular facet screws

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