Percutaneous translaminar facet pedicle screw fixation following anterior lumbar interbody fusion
Chan Shik Shim, Sang-Ho Lee, Byungjoo Jung, Sun-Hee Park, Song-Woo Shin
Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
Keywords: Biomechanics; bone screws; intervertebral disk displacement/surgery; joint instability; lumbar vertebrae/surgery; prostheses and implants; spinal fusion/instrumentation/methods.
Objectives: This retrospective study was conducted to describe a novel minimally invasive translaminar facet pedicle screw fixation technique that was modified from the Magerl's method and to assess its technical feasibility and clinical efficacy.
Patients and methods: Twenty consecutive patients (19 females, 1 male; mean age 54 years; range 41 to 68 years) with degenerative spinal disease underwent anterior lumbar interbody fusion (ALIF) and supplementary percutaneous translaminar facet screw fixation under fluoroscopic guidance, in which the screw was directed to purchase with the pedicle while traversing the laminae and transfixing the facet. Spinal fusion was performed at 1, 2, and 3 levels in 10, 7, and 3 patients, respectively. The results were evaluated with the use of the visual analog scale (VAS) and the Oswestry Disability Index (ODI). The patients were evaluated by computed tomography (CT) and radiographs immediately after the operation and at the last follow-up. The mean follow-up period was 19.5 months (range 10 to 28 months).
Results: A total of 65 screws were inserted. Seven screws (10.8%) were found to have violated laminae walls on immediate postoperative CT scans. Screw-associated direct neural injury or neural compression did not occur. Facet purchases were successful in all the screws, but pedicle purchases were successful in 55 screws (84.6%). Radiologic fusion occurred in all the cases. The mean preoperative ODI score decreased from 52% to 26%, and the mean preoperative VAS scores for pain and leg pain decreased from 8.5 to 4.5 and from 6.25 to 2.3, respectively. The mean operation time was 57 minutes per level for ALIF and 47 minutes per level for percutaneous translaminar transfacet screw fixation. There was only one complication related to facet screw fixation that necessitated revision.
Conclusion: Percutaneous translaminar facet pedicle screw fixation with the use of fluoroscopy is a technically feasible minimally invasive posterior augmentation method following anterior lumbar interbody fusion.