Effection of monoplanar pedicle screw on facet joint degeneration in thoracolumbar vertebral fractures

Abstract

Background This study aimed to compare the clinical outcomes and effect on instrument-related facet joints between fixed-axis pedicle screw (FAPS) and monoplanar pedicle screw (MPPS). Methods 816 pedicle screws of 204 patients with thoracolumbar vertebral fractures (TLVF) who underwent internal fixation surgery were analyzed in this retrospective study. All patients were divided into two groups (FAPS and MPPS). Preoperative, immediate postoperative, and 12–18-months postoperative CT and X-ray, and clinical data, including demographics, preoperative and immediate postoperative Visual Analogue Scale (VAS), blood loss (BL), operation time (OT) and hospital stay time (HST), were collected. Facet joint violation and degeneration grade were evaluated by CT according to Babu’s criteria and Weishaupt’s criteria respectively, and preoperative, immediate postoperative and 12–18-months postoperative anterior body compression index (ABCI) were measured by X-ray. Results Postoperative VAS of two groups was lower than preoperative VAS (p < 0.05). BL, OT, and HST were less in MPPS than FAPS, and the difference was statistically significant in BL and HST (p < 0.05) but no in OT (p > 0.05). Immediate postoperative and 12–18-months postoperative ABCI were significantly higher than preoperative (p < 0.05), and the difference of ABCI between immediate postoperative and 12–18-months postoperative were not significant in two groups (p > 0.05). Total violation rate (VR) was about 1.35% (11/816) and FAPS had a lower VR than MPPS, but no significant (p > 0.05). Weishaupt’s criteria revealed that average class (AC) was 0.69 in FAPS and 0.67 in MPPS, and the distribution of degenerated facet joints in two groups did not differ preoperatively (p > 0.05). In 12–18 months postoperatively, AC was significantly higher in FAPS than in MPPS, and the distribution of degenerated facet joints in two groups was significantly different (p < 0.05). The comparison of cranial to caudal joints in two groups revealed that cranial joints had more severe degeneration than caudal joints. Conclusions The findings suggested that both MPPS and FAPS were effective for patients with TLVF, but MPPS by percutaneous may be a better choice to avoid adjacent segment degeneration, especially the surgery-involved facet joints degeneration.

Percutaneous monoplanar screws versus hybrid fixed axial and polyaxial screws in intermediate screw fixation for traumatic thoracolumbar burst fractures: a case–control study

“…Similarly, a clinical study by Huang et al [ 37 ] indicated that MSs fixation achieved better correction effect and less correction loss than polyaxial screw fixation alone. According to Ye et al [ 38 ] MS probably a superior option to reduce the incidence of degeneration of the injured vertebral adjacent segment than fixed axial screw.…”

Novel uniplanar pedicle screw systems applied to thoracolumbar fractures: a biomechanical study

“…Patients treated with UPPS experienced less intraoperative bleeding and spent less time in the hospital. Additionally, when it comes to restoring the anterior vertebral body’s height following surgery, UPPS and FAPS have comparable results ( Ye et al, 2022 ). This demonstrates that UPPS combines the advantages of FAPS and PAPS, ensuring sufficient biomechanical stability while facilitating the operation and reducing the risk of postoperative complications.…”

Oblique lateral interbody fusion stand-alone vs. combined with percutaneous pedicle screw fixation in the treatment of discogenic low back pain

“…PPSF may increase ASD has been reported in the literature ( 19 ). The reason for this may be that the posterior lumbar spine surgery damages the lower back muscles and adjacent facet joints ( 49 , 50 ), increasing ASD. Limited by the number of cases, our study did not find a statistically significant reduction in ASD with OLIF stand-alone.…”