Superior facet joint violation between open and minimally invasive techniques in lumbar fusion surgery: An updated systematic review and meta-analysis

Abstract

Background: Superior facet joint violation (FJV) is a potential risk factor for adjacent segment disease following lumbar fusion surgery. We sought to conduct a systematic review and meta-analysis to compare screw-related superior FJV rates between the open and different minimally invasive (MI) techniques-fluoroscopy-based, 3D-image navigation, and navigation with robotic assistance-in adult lumbar fusion surgery. Methods: We searched original articles comparing the rates of screw-related FJV between the open and different MI techniques in adult lumbar fusion surgery for lumbar degenerative diseases in PubMed, EMBASE, and the Cochrane Library from inception to September 2021. We compared the numbers of top-level pedicle screws and associated superior FJVs in the main analyses and performed subgroup analysis based on different MI techniques to examine whether individual MI approaches differed in superior FJV rate. Risk ratio (RR) and 95% confidence interval (CI) were calculated in a random-effect meta-analysis. Results: Included in the meta-analysis were 16 articles with 2655 patients and 4638 top-level pedicle screws. The pooled analysis showed no significant difference in superior FJV rates between the MI and open groups (RR: 0.89, 95% CI: 0.62-1.28). The subgroup analysis demonstrated that the overall rates of superior FJV were 27.1% (411/1518) for fluoroscopy-based, 7.1% (43/603) for 3D-image navigation, and 3.2% (7/216) for navigation with robotic assistance. Compared with the open method, the overall RRs were 1.53 (95% CI: 1.19-1.96) for fluoroscopy-based, 0.41 (95% CI: 0.22-0.75) for 3D-image navigation, and 0.25 (95% CI: 0.08-0.72) for navigation with robotic assistance. Conclusion: Among the three common MI techniques, fluoroscopy-based can be associated with a higher risk of superior FJV, while both 3D-image navigation and navigation with robotic assistance may be associated with lower risks as compared with the open method. Considering the limitations of the study, more trials are needed to prove these clinical findings.

Early oral diet may enhance recovery from benign gynecologic surgery: A prospective study in single medical center

“…Finally, we found that some independent factors, such as laparoscopic surgery and lower VAS scores, were related to reduced hospital stay. Minimally invasive surgery, 2,8 including robotic surgery, 9,10 natural orifice surgery, 35,36,38 and laparoscopic surgery, 12,35,37–39 has become increasingly popular in recent decades, although some controversial issues remain. 41 Additionally, adequate pain control is the milestone for successful surgical treatment and should always be applied.…”

“…However, laparotomy requires a large incision and is associated with wound-related morbidities, such as wound pain. 7,8 For laparoscopic surgery, which is minimally invasive [9][10][11] compared with conventional exploratory surgery, the advantages include smaller wounds with cosmetic benefits, less wound infection risk, and less postoperative pain; however, some minimally invasive approach-related adverse events, such as gas embolism, emphysema, and surgical positioning-or instrument-related complications, among others may occur. 12 Finally, the patients also expressed their preferences and beliefs, and SDM was performed after comprehensive discussions between surgeons and patients.…”

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

“…In our study, facet angle, facet joint hypertrophy, and pedicle screw angle were the independent in uencing factors of the FJV. Previous studies [7,9,10,11,14,15,16]have agreed that the facet angle is one of the main in uencing factors for the occurrence of FJV, because the larger the facet angle, the more outward the opening of the facet joint is in the axial plane, and the easier it is for the pedicle screw to violate into the facet joint during screw placement.…”

“…The development direction of spinal surgery is minimally invasive, so previous studies investigating the risk factors of FJV have focused on minimally invasive surgery, but it is undeniable that at present and for a long time to come, traditional PLIF surgery is still one of the main lumbar spine surgical procedures. With the development of technology, 3D navigation-assisted screwing has emerged, and some studies have shown that 3D navigation-assisted screw placement can effectively reduce the incidence of FJV [ 9 ], but based on the high cost of 3D navigation systems, freehand screwing is still the mainstay in more underdeveloped areas. Therefore, it is of su cient practical signi cance to explore the risk factors for the occurrence of FJV in traditional PLIF surgery.…”

Minimally invasive approach is preferred for clinical stage 1 endometrioid-type endometrial cancer

“…In recent years, minimally invasive surgery (MIS) has become one of the leading advanced therapeutic technology in the management of patients with various types of benign diseases, not only due to successful transformation of the treatment landscape but also clear demonstration of many advantages, such as small wound, better cosmetics, less wound pain, sooner recovery, and easy fulfillments of enhanced recovery after surgery (ERAS) programs compared to conventional exploratory laparotomic approach. [1][2][3][4][5][6] However, for the management of patients with malignant tumors, there are many debated issues and controversies, although many studies have confirmed that MIS can be successfully in place of traditional exploratory laparotomy in the management of many kinds of malignancies, based on the validated effectiveness and safety of MIS. [7][8][9][10][11][12] Among the aforementioned cancers, the gynecological organ-related cancers may be one of highly debated issues, because the preferred surgical therapy for endometrioid-type endometrial cancer (E-EC) is an MIS (laparoscopic surgery or robotic surgery) and the choice of treatment for epithelial ovarian cancer (EOC) is a standard midline incision-based exploratory laparotomy.…”