Incidence and risk factors associated with superior-segmented facet joint violation during minimal invasive lumbar interbody fusion

Singhatanadgige, Weerasak; Jaruprat, Peeradon; Kerr, Stephen J.; Yingsakmongkol, Wicharn; Kotheeranurak, Vit; Limthongkul, Worawat

doi:10.1016/j.spinee.2022.04.002

Cited by 2 publications

(16 citation statements)

References 22 publications

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“…Several previous studies [11,14,16]and our study have concluded that a smaller pedicle screw leads to a higher incidence of FJV, and it was an in uence that can be arti cially altered. Therefore, we think the surgeons should pay more attention to the entry points, appropriately make the screwing point more laterally oriented and increase the pedicle screw angle, which maybe contribute to the reduction in the incidence of FJV.…”

Section: Discussionsupporting

confidence: 54%

“…Facet joint degeneration was concluded have no association with FJV by Zhao et al and us, whereas the view of Singhatanadgige et al was the opposite of ours. [14]. The differences may be due to the different emphasis of different researchers in evaluating facet joint degeneration and the variability of data.…”

Section: Discussionmentioning

confidence: 99%

“…Because preoperative diagnosis wasn't imaging parameters, so it wasn't taken into multivariate binary logistic regression analysis by us although it signi cantly correlated with FJV in our study. Zhao, Singhatanadgige, et al [14,16] concluded that there was no signi cant difference in the probability of FJV between preoperative diagnoses, while Park, Wang, et al [13,19 ] had opposite views. But Park et al [13] concluded that Isthmic lumbar spondylolisthesis had the highest probability of FJV, followed by lumbar disc herniation/lumbar stenosis, and degenerative lumbar spondylolisthesis had the lowest probability of FJV.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and risk factors associated with superior segmented facet joint violation in posterior approach lumbar interbody fusion

Fan,

Chen,

Liu

et al. 2023

Preprint

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Objective: To investigate the incidence and risk factors of superior-segmented facet joint violation (FJV) during pedicle screw placement in posterior approach lumbar interbody fusion (PLIF). Study type: Retrospective study. Methods: A total of 320 patients with lumbar degenerative diseases who underwent PLIF surgery in our hospital from 2018 to 2021 were retrospectively analyzed. The pedicle screws of all the patients were placed by freehand. The lumbar computed tomography examinations were conducted within 2 weeks after surgery to evaluate the degree of facet joint violation. The facet Joint degeneration, facet joint hypertrophy, facet angle, pedicle angle, depth of lamina, pedicle screw angle, and screw-endplate angle were measured or evaluated by CT images. General condition, preoperative diagnosis, superior screw placement level (L4 or L5), degree of vertebral slippage, and screw side (left or right) were also included in the analysis. Difference analysis (chi-square test/T-test) and multivariate binary logistic regression analysis were conducted to determine which factors had an effect on FJV. Results: 640 superior pedicle screws of 320 patients were analyzed in this study. The incidence of superior facet joint violation was 44.69% (286/320). The BMI (P=0.225), age (P=0.786), gender (P=0.701), facet joint degeneration (P=0.082), degree of vertebral slippage (P=0.15), depth of the lamina (P=0.307) and screw-endplate angle (P=0.807) were not associated with FJV. The preoperative diagnosis (P<0.001), superior screw placement level(P<0.001), screw side (P=0.004), facet angle (P<0.001), pedicle angle (P<0.001), pedicle screw angle (P<0.001), and facet joint hypertrophy (P=0.017) were associated with FJV, with facet angle(P<0.001), facet joint hypertrophy (P=0.044), and pedicle screw angle(P<0.001) as independent influences on FJV. Conclusion: The larger facet angle, the smaller pedicle screw angle and facet joint hypertrophy were independent risk factors for FJV, and the cut off value of facet angle and pedicle screw angle were 43.38° and 14.67° respectively. More care should be taken to avoid FJV when the preoperative diagnosis was isthmic lumbar spondylolisthesis and the screw placement level was at L5 level.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Incidence and risk factors associated with superior segmented facet joint violation in posterior approach lumbar interbody fusion

Fan,

Chen,

Liu

et al. 2023

Preprint

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“…Although it is considered standard practice to attempt avoidance of FJV when placing pedicle screws during lumbar fusion surgery, multiple studies have demonstrated a persistent rate of FJV regardless of surgical technique and despite recent developments in intraoperative imaging, surgical navigation, and robotic assistance. [1][2][3][4][5][6][7][8][9][10][11] Previously reported FJV rates have ranged from 2.8 to 100% and depend in large part on somewhat arbitrary definitions of FJV. [1][2][3][13][14][15][16] The facet joint complex consists of the facet joint capsule and opposing superior and inferior articular facets from adjacent vertebrae.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, inadvertent screw malposition and screwassociated violation of adjacent facet joints (FJV) remains a potential complication of the procedure regardless of whether surgery is performed in open fashion or with minimally invasive techniques and despite the use of intraoperative imaging or surgical navigation. [1][2][3][4][5][6][7][8][9][10][11] Given the proximity of the lumbar vertebral pedicle to the proximal facet joint, FJV occurs almost exclusively at the level of the proximal as opposed to the distal unfused spinal segment, and the rate of FJV in previous series has been reported as ranging from 2.8-100%. 1,2,[12][13][14][15][16] Although previous studies have suggested that FJV is associated with worse post-operative patient reported outcomes (PROs) in terms of low back pain and disability, [17][18][19] there is no published data regarding the potential impact of FJV on postoperative radiologic fusion rates.…”

Section: Introductionmentioning

confidence: 98%

Pedicle Screw-Associated Violation of the Adjacent Unfused Facet Joint: Clinical Outcomes and Fusion Rates

Sinz

Hwang

Lee

et al. 2022

Global Spine Journal

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Study Design Retrospective review of a prospective randomized trial. Objectives To compare outcome scores and fusion rates in patients with and without pedicle screw-associated facet joint violation (FJV) after a single-level lumbar fusion. Methods Clinical outcomes data and computed tomography (CT) imaging were reviewed for 157 patients participating in a multicenter prospective trial. Post-operative CT scans at 12-months follow-up were examined for fusion status and FJV. Patient-reported outcomes (PROs) included Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for leg and low back pain. Chi-square test of independence was used to compare proportions between groups on categorical measures. Two-sample t-test was used to identify differences in mean patient outcome scores. Logistic regression models were performed to determine association between FJV and fusion rates. Results Of the 157 patients included, there were 18 (11.5%) with FJV (Group A) and 139 (88.5%) without FJV (Group B). Patients with FJV experienced less improvement in ODI (P = .004) and VAS back pain scores (P = .04) vs patients without FJV. There was no difference in mean VAS leg pain (P = .4997). The rate of fusion at 12-months for patients with FJV (27.8%) was lower compared to those without FJV (71.2%) (P = .0002). Patients with FJV were 76% less likely to have a successful fusion at 12-months. Conclusion Pedicle screw-associated violation of the adjacent unfused facet joint during single-level lumbar fusion is associated with less improvement in back pain, back pain-associated disability, and a lower fusion rate at 1-year after surgery.

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Incidence and risk factors associated with superior-segmented facet joint violation during minimal invasive lumbar interbody fusion

Cited by 2 publications

References 22 publications

Incidence and risk factors associated with superior segmented facet joint violation in posterior approach lumbar interbody fusion

Incidence and risk factors associated with superior segmented facet joint violation in posterior approach lumbar interbody fusion

Pedicle Screw-Associated Violation of the Adjacent Unfused Facet Joint: Clinical Outcomes and Fusion Rates

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