Computed Tomography Evaluation of Superior-Segment Facet-Joint Violation After Pedicle Instrumentation of the Lumbar Spine With a Midline Surgical Approach

Moshirfar, Ali; Jenis, Louis G.; Spector, Leo R.; Burke, Patrick J.; Losina, Elena; Katz, Jeffrey N.; Rand, Frank; Tromanhauser, Scott; Banco, Robert

doi:10.1097/01.brs.0000240691.35707.e8

Cited by 87 publications

(68 citation statements)

References 10 publications

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“…Fusion procedures have been linked to a variety of negative side effects such as adjacent segment degeneration and instability, superior segment facet joint violation, adjacent segment spondylarthrosis with consecutive spinal canal stenosis as well as persisting pain from harvesting of the autologous bone graft [9,21,23,30,35,49,63]. Previous studies have revealed the facet and iliosacral joints to be a source of post-operative pain in a considerable number of patients [29,42,43].…”

Section: Discussionmentioning

confidence: 99%

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

Siepe¹,

Korge²,

Grochulla³

et al. 2007

Eur Spine J

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Although a variety of biomechanical laboratory investigations and radiological studies have highlighted the potential problems associated with total lumbar disc replacement (TDR), no previous study has performed a systematic clinical failure analysis. The aim of this study was to identify the post-operative pain sources, establish the incidence of post-operative pain patterns and investigate the effect on post-operative outcome with the help of fluoroscopically guided spine infiltrations in patients from an ongoing prospective study with ProDisc II. Patients who reported unsatisfactory results at any of the FU-examinations received fluoroscopically guided spine infiltrations as part of a semi-invasive diagnostic and conservative treatment program. Pain sources were identified in patients with reproducible (C29) significant (50-75%) or highly significant (75-100%) pain relief. Results were correlated with outcome parameters visual analogue scale (VAS), Oswestry disability index (ODI) and the subjective patient satisfaction rate. From a total of 175 operated patients with a mean follow-up (FU) of 29.3 months (range 12.2-74.9 months), n = 342 infiltrations were performed in n = 58 patients (33.1%) overall. Facet joint pain, predominantly at the index level (86.4%), was identified in n = 22 patients (12.6%). The sacroiliac joint was a similarly frequent cause of post-operative pain (n = 21, 12.0%). Pain from both structures influenced all outcome parameters negatively (P \ 0.05). Patients with an early onset of pain (B6 months) were 2-59 higher at risk of developing persisting complaints and unsatisfactory outcome at later FU-stages in comparison to the entire study cohort (P \ 0.05). The level of TDR significantly influenced postoperative outcome. Best results were achieved for the TDRs above the lumbosacral junction at L4/5 (incidence of posterior joint pain 14.8%). Inferior outcome and a significantly higher incidence of posterior joint pain were observed for TDR at L5/S1 (21.6%) and bisegmental TDR at L4/5/S1 (33.3%), respectively. Lumbar facet and/or ISJpain are a frequent and currently underestimated source of post-operative pain and the most common reasons for unsatisfactory results following TDR. Further failureanalysis studies are required and adequate salvage treatment options need to be established with respect to the underlying pathology of post-operative pain. The question as to whether or not TDR will reduce the incidence of posterior joint pain, which has been previously attributed to lumbar fusion procedures, remains unanswered. Additional studies will have to investigate whether TDR compromises the index-segment in an attempt to avoid adjacent segment degeneration.

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Section: Discussionmentioning

confidence: 99%

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

Siepe¹,

Korge²,

Grochulla³

et al. 2007

Eur Spine J

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“…Total lumbar disc replacement Fusion of lumbar motion segments has been associated with a variety of early and late complications in a considerable number of patients [1][2][3][4][5][6][7][8][9][10][11][12]. In an attempt to avoid these fusion-related negative side effects, motion preserving technologies such as total lumbar disc replacement (TDR) procedures have been introduced.…”

Section: Ddd Versus Preoperative Clinical Symptomatologymentioning

confidence: 99%

Influence of lumbar intervertebral disc degeneration on the outcome of total lumbar disc replacement: a prospective clinical, histological, X-ray and MRI investigation

Siepe¹,

Heider²,

Haas

et al. 2012

Eur Spine J

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“…However, a variety of negative side effects have been linked with both the posterior approach as well as the fusion of lumbar motion segments. These negative side effects include access-related collateral muscle damage, sagittal imbalance, graft site morbidity, screw loosening, pseudarthrosis, adjacent level facet joint violations in posterior instrumented fusion techniques, high rates of adjacent level pathologies as well as considerable complication and reoperation rates [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Anterior stand-alone fusion revisited: a prospective clinical, X-ray and CT investigation

et al. 2014

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The current study delineates satisfactory clinical results following ASAF at the lumbosacral junction. Patient safety was demonstrated with acceptable complication and low reoperation rates. Radiological data demonstrated a significant reconstruction of lordosis at the lumbosacral junction. Solid interbody fusion was achieved in 97.3 % of all cases in a highly selected cohort with optimal predisposition for fusion. ASAF may serve to avoid a variety of negative side effects for a considerable number of patients which, otherwise, would have been candidates for posterior instrumented fusion techniques.

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Computed Tomography Evaluation of Superior-Segment Facet-Joint Violation After Pedicle Instrumentation of the Lumbar Spine With a Midline Surgical Approach

Abstract: The left side, single-level fusion, and most cephalad pedicle screws at L5 are targets for interventions to reduce pedicle violations in this procedure.

Cited by 87 publications

References 10 publications

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

Influence of lumbar intervertebral disc degeneration on the outcome of total lumbar disc replacement: a prospective clinical, histological, X-ray and MRI investigation

Anterior stand-alone fusion revisited: a prospective clinical, X-ray and CT investigation

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