Incidence and Risk Factors for Facet Joint Violation in Open Versus Minimally Invasive Procedures During Pedicle Screw Placement in Patients with Trauma

Herren, Christian; Reijnen, Marly; Pishnamaz, Miguel; Lichte, Philipp; Andruszkow, Hagen; Nebelung, Sven; Siewe, Jan; Hildebrand, Frank; Kobbe, Philipp

doi:10.1016/j.wneu.2018.01.138

Cited by 24 publications

(24 citation statements)

References 33 publications

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“…The incidence of facet violation was reported at 8% to 47% when using pedicle screws. [17][18][19] In addition, a broad range of soft tissue dissection is necessary when inserting screws. Capsular disruption in addition to ligamentous and muscular disruption in PSF could increase susceptibility to PJK.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Proximal Junctional Kyphosis With Pedicle Screws at Upper Instrumented Vertebrae in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Ogura

Glassman

Sucato

et al. 2020

Global Spine Journal

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Study Design: Longitudinal cohort. Objectives: Posterior spinal fusion (PSF) using all-pedicle screw constructs has become the standard procedure in the treatment of adolescent idiopathic scoliosis (AIS). However, there have been several reports that all-pedicle screw constructs or the use of pedicle screws at the upper instrumented vertebrae (UIV) increases the incidence of proximal junctional kyphosis (PJK). We aimed to evaluate the impact of instrumentation type on the incidence of PJK following PSF for AIS. Methods: We performed a stratified random sampling from 3654 patients enrolled in a multicenter database of surgically treated AIS to obtain a representative sample from all Lenke types. Patients were then allocated into 3 groups based on the instrumentation type: all-pedicle screw (PS), hook at UIV with pedicle screws distally (HT), and hybrid constructs (HB). We measured proximal junctional angle (PJA) and defined PJK as PJA ≥ 10° and PJA progression of >10° at the final follow-up. Results: Fifteen (4.3%) of 345 cases had PJK. PJK was significantly more common in PS (11%) compared with HB (1%) and HT (0%) ( P < .001). PJK patients were similar to non-PJK patients regarding age, sex, curve type, UIV, and preoperative coronal Cobb angle. Thoracic kyphosis was significantly higher in the PJK group before surgery. Patients who developed PJK had a statistically significantly larger negative sagittal balance compared with the non-PJK group. Conclusion: The incidence of PJK was 4.3% and was more common in all-pedicle screw constructs. Using hooks at UIV might be a treatment strategy to limit PJK.

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Section: Discussionmentioning

confidence: 99%

Incidence of Proximal Junctional Kyphosis With Pedicle Screws at Upper Instrumented Vertebrae in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Ogura

Glassman

Sucato

et al. 2020

Global Spine Journal

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“…In contrast, open surgery provides more three-dimensional and intuitive visualization, which helps to determine the screw entry point. In recent years, percutaneous screw placement has been reported to have a higher risk of superior segment facet joint injury than traditional open screw placement [3,4]. A finite element analysis by Kim et al suggested that the degree of screw invasion into the intervertebral joints is associated with increased stress of the facet joints and increased pressure of the adjacent discs [7].…”

Section: Discussionmentioning

confidence: 99%

“…If combined with MIS-TLIF, the fixation technique can further reduce iatrogenic injury of the lumbar and back muscles. However, studies have shown that invasion of the superior segment facet joint is more common in percutaneous screw placement than in open surgery [3,4]. Biomechanical tests, finite element analysis, and clinical studies have shown that screw invasion of the upper facet joints can change the stress distribution of the facet joints to result in the spontaneous fusion of the facet joints and the occurrence of spondylolisthesis in the adjacent disc(s) and increase the likelihood of revision surgery in the future [5–8].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Robot-Assisted Percutaneous Pedicle Screw Placement for Treatment of Lumbar Spondylolisthesis: A Comparative Cohort Study

Yang

Tian

et al. 2019

Med Sci Monit

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Background With the in-depth development of minimally invasive spine surgery in recent years, robot- and computer-assisted technologies have been increasingly used and successfully applied to spinal surgery. Material/Methods We performed a retrospective analysis of 60 patients with grade I or II lumbar spondylolisthesis who underwent minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) from January 2017 to December 2017. A robot-assisted surgical system was used in 30 patients for pedicle screw placement. The other 30 patients underwent fluoroscopy-guided percutaneous pedicle screw placement. Results There were 130 screws placed under fluoroscopic guidance, with 26.2% penetration of the pedicle wall. There were 130 screws placed in robotic-assisted surgery, with 6.2% penetration of the pedicle wall. Severe screw deviation (Neo grade III) was identified in 4 screws in the fluoroscopy-guided group, while no severe deviation was noted in the robot-assisted group. In the fluoroscopic group, 15.6% of screws penetrated the superior articular process, and 2.1% screws had severe complications (Babu grade III). However, only 5.1% of screws in the robot-assisted group had severe complications. The mean screw insertion angle was significantly greater in the robot-assisted group than in the fluoroscopy-guided group (23.8±6.1° vs. 18.4±7.2°, P=0.017). Conclusions Compared to fluoroscopy-guided percutaneous pedicle screw placement, robot-assisted percutaneous pedicle screw placement has the following advantages: greater accuracy, lower incidences of screw penetration of the pedicle wall and invasion of the facet joints, and better screw insertion angle. Combined with MIS-TLIF, robot-assisted percutaneous pedicle screw placement is an effective minimally invasive treatment for lumbar spondylolisthesis.

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“…Meanwhile, the articular surface of the facet joint also shifted to the lateral and coronal planes, blocking the insertion trajectory and ultimately increasing proximal FJV. [22,31] Moreover, patients with facet angle ≥45° were 1.89 times more likely have a proximal FJV than patients with facet angle 45°. When the facet angle increases, the surface of facet joint gradually deviates to the coronal position, thereby blocking the trajectory of screws.…”

Section: Discussionmentioning

confidence: 98%

Safety and Risk Factors of Tinavi Robot-assisted Percutaneous Pedicle Screw Placement in Spinal Surgery

Zhang

Zhou

Zhang

et al. 2021

Preprint

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Objective To determine the rates and risk factors of pedicle screw placement accuracy and the proximal facet joint violation (FJV) using TINAVI robot-assisted technique.Methods Patients with thoracolumbar fractures or degenerative diseases were retrospectively recruited from June 2018 and June 2020. The pedicle penetration and proximal FJV were compared in different instrumental levels to identify the safe and risk segments during insertion. Moreover, the factors were also assessed using univariate and multivariate analyses.Results A total of 72 patients with 332 pedicle screws were included in the current study. The optimal and clinically acceptable screw positions were 85.8% and 93.4%. Of the 332 screws concerning the intra-pedicular accuracy, 285 screws (85.8%) were evaluated as grade A according to the Gertzbein and Robbins scale, with the remaining 25 (7.6%), 10 (3.0%), 6 (1.8%), and 6 screws (1.8%) as grade B, C, D, and E. Moreover, in terms of the proximal FJV, 255 screws (76.8%) screws were assessed as grade 0 according to the Babu scale, with the remaining 34 (10.3%), 22 (6.6%), and 21 screws (6.3%) as grade 1, 2, and 3. Furthermore, the univariate analysis showed significantly higher rate of penetration for patients with age＜61 years old, sex of female, thoracolumbar insertion, shorter distance from skin to insertion point, and smaller facet angle. Meanwhile, the patients with the sex of female, BMI <25.9, grade I spondylolisthesis, lumbosacral insertion, longer distance from skin to insertion point, and larger facet angle had a significantly higher rate of proximal FJV. The outcomes of multivariate analyses showed that sex of male (adjusted OR 0.320, 95% CI 0.140–0.732; p =0.007), facet angle ≥45° (adjusted OR 0.266, 95% CI 0.090–0.786; p =0.017), distance from skin to insertion point ≥4.5cm (adjusted OR 0.342, 95% CI 0.134–0.868; p =0.024), and lumbosacral instrumentation (adjusted OR 0.227, 95% CI 0.091–0.566; p =0.001) were independently associated with intra-pedicular accuracy; the L5 insertion (adjusted OR 2.020, 95% CI 1.084–3.766; p =0.027) and facet angle ≥45° (adjusted OR 1.839, 95% CI 1.026–3.298; p =0.041) were independently associated with the proximal FJV.Conclusion TINAVI robot-assisted technique was associated with a high rate of pedicle screw placement and a low rate of proximal FJV. This new technique showed a safe and precise performance for pedicle screw placement in spinal surgery. Facet angle ≥45° is independently associated with both the intra-pedicular accuracy and proximal FJV.

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Incidence and Risk Factors for Facet Joint Violation in Open Versus Minimally Invasive Procedures During Pedicle Screw Placement in Patients with Trauma

Cited by 24 publications

References 33 publications

Incidence of Proximal Junctional Kyphosis With Pedicle Screws at Upper Instrumented Vertebrae in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Incidence of Proximal Junctional Kyphosis With Pedicle Screws at Upper Instrumented Vertebrae in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Accuracy of Robot-Assisted Percutaneous Pedicle Screw Placement for Treatment of Lumbar Spondylolisthesis: A Comparative Cohort Study

Safety and Risk Factors of Tinavi Robot-assisted Percutaneous Pedicle Screw Placement in Spinal Surgery

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