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Prospective evaluation of 1-year outcomes in single-level percutaneous lumbar transfacet screw fixation in the lateral decubitus position following lateral transpsoas interbody fusion

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Abstract

Purpose

Lateral transpsoas lumbar interbody fusion (LTIF) is an accepted treatment for degenerative lumbar disc disease. Bilateral percutaneous transfacet (TF) fixation is a promising option for stabilization following LTIF. Here, we describe our experience with this technique and assess the clinical outcomes and efficacy.

Methods

Thirty-eight consecutive patients were identified who underwent LTIF followed by bilateral percutaneous transfacet fixation in the lateral position. Preoperative and 1-year postoperative VAS scores, and operative data were prospectively recorded. One-year outcomes were also assessed according to the MacNab criteria. Fusion was assessed at 1 year via computed tomography and dynamic radiography. Two-tailed Student’s t test was used to compare VAS scores.

Results

Twenty-six patients underwent fusion at L4–5, 11 at L3–4, and one at L2–3; two patients were lost to follow-up. Mean operative time was 148.0 ± 47.9 min; mean blood loss was 33.0 ± 26.1 ml; mean hospital stay was 53.5 ± 51.2 h. Mean preoperative VAS scores for back and leg pain were 7.4 ± 3.0 and 7.0 ± 2.9, respectively; mean postoperative VAS scores for back and leg pain were 1.9 ± 2.4 (p < 0.0001) and 2.0 ± 3.0 (p < 0.0001), respectively. Most (89 %) patients had some relief, 72 % good to excellent and 17 % fair outcomes; eleven percent had little to no relief. There was one postoperative complication (pulmonary embolus). All patients had evidence of solid bony fusion.

Conclusions

Percutaneous transfacet fixation in the lateral position is a safe and effective alternative for fixation after LTIF and may be associated with shorter operative time and less blood loss than other posterior fixation techniques.

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References

  1. Rodgers WB, Gerber EJ, Patterson J (2011) Intraoperative and early postoperative complications in extreme lateral interbody fusion: an analysis of 600 cases. Spine (Phila Pa 1976) 36:26–32

    Article  Google Scholar 

  2. Isaacs RE, Hyde J, Goodrich JA, Rodgers WB, Phillips FM (2010) A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and complications. Spine (Phila Pa 1976) 35:S322–S330

    Article  Google Scholar 

  3. Dakwar E, Cardona RF, Smith DA, Uribe JS (2010) Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis. Neurosurg Focus 28:E8

    Article  PubMed  Google Scholar 

  4. Youssef JA, McAfee PC, Patty CA, Raley E, De Bauche S, Shucosky E, Chotikul L (2010) Minimally invasive surgery: lateral approach interbody fusion: results and review. Spine (Phila Pa 1976) 35:S302–S311

    Article  Google Scholar 

  5. Ferrara LA, Secor JL, Jin BH, Wakefield A, Inceoglu S, Benzel EC (2003) A biomechanical comparison of facet screw fixation and pedicle screw fixation: effects of short-term and long-term repetitive cycling. Spine (Phila Pa 1976) 28:1226–1234

    Google Scholar 

  6. Jang JS, Lee SH (2005) Clinical analysis of percutaneous facet screw fixation after anterior lumbar interbody fusion. J Neurosurg Spine 3:40–46

    Article  PubMed  Google Scholar 

  7. Kim SM, Lim TJ, Paterno J, Kim DH (2004) A biomechanical comparison of supplementary posterior translaminar facet and transfaceto pedicular screw fixation after anterior lumbar interbody fusion. J Neurosurg Spine 1:101–107

    Article  PubMed  Google Scholar 

  8. Mahar A, Kim C, Oka R, Odell T, Perry A, Mirkovic S, Garfin S (2006) Biomechanical comparison of a novel percutaneous transfacet device and a traditional posterior system for single level fusion. J Spinal Disord Tech 19:591–594

    Article  PubMed  Google Scholar 

  9. Chin KR, Reis MT, Reyes PM, Newcomb AG, Neagoe A, Gabriel JP, Sung RD, Crawford NR (2013) Stability of transforaminal lumbar interbody fusion in the setting of retained facets and posterior fixation using transfacet or standard pedicle screws. Spine J. doi:10.1016/j.spinee.2013.06.103

  10. Voyadzis JM, Anaizi AN (2013) Minimally invasive lumbar transfacet screw fixation in the lateral decubitus position after extreme lateral interbody fusion: a technique and feasibility study. J Spinal Disord Tech 26:98–106

    Article  PubMed  Google Scholar 

  11. Macnab I (1971) Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg Am 53:891–903

    CAS  PubMed  Google Scholar 

  12. Ozgur BM, Aryan HE, Pimenta L, Taylor WR (2006) Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 6:435–443

    Article  PubMed  Google Scholar 

  13. Su BW, Cha TD, Kim PD, Lee J, April EW, Weidenbaum M, Albert TJ, Vaccaro AR (2009) An anatomic and radiographic study of lumbar facets relevant to percutaneous transfacet fixation. Spine (Phila Pa 1976) 34:E384–E390

    Article  Google Scholar 

  14. Buckwalter JA (1995) Aging and degeneration of the human intervertebral disc. Spine (Phila Pa 1976) 20:1307–1314

    CAS  Google Scholar 

  15. Verbiest H (1954) A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg Br 36:230–237

    PubMed  Google Scholar 

  16. Matsudaira K, Yamazaki T, Seichi A, Takeshita K, Hoshi K, Kishimoto J, Nakamura K (2005) Spinal stenosis in grade I degenerative lumbar spondylolisthesis: a comparative study of outcomes following laminoplasty and laminectomy with instrumented spinal fusion. J Orthop Sci 10:270–276

    Article  PubMed  Google Scholar 

  17. Weinstein JN, Tosteson TD, Lurie JD, Tosteson A, Blood E, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H (2010) Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976) 35:1329–1338

    Article  Google Scholar 

  18. Martin CR, Gruszczynski AT, Braunsfurth HA, Fallatah SM, O’Neil J, Wai EK (2007) The surgical management of degenerative lumbar spondylolisthesis: a systematic review. Spine (Phila Pa 1976) 32:1791–1798

    Article  Google Scholar 

  19. Fritzell P, Hagg O, Wessberg P, Nordwall A (2001) 2001 Volvo Award Winner in Clinical Studies: lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine (Phila Pa 1976) 26:2521–2532 discussion 2532–2524

    Article  CAS  Google Scholar 

  20. Capener N (1932) Spondylolisthesis. Br J Surg 19:374–386

    Article  Google Scholar 

  21. Rajaraman V, Vingan R, Roth P, Heary RF, Conklin L, Jacobs GB (1999) Visceral and vascular complications resulting from anterior lumbar interbody fusion. J Neurosurg 91:60–64

    CAS  PubMed  Google Scholar 

  22. Brau SA, Delamarter RB, Schiffman ML, Williams LA, Watkins RG (2004) Vascular injury during anterior lumbar surgery. Spine J 4:409–412

    Article  PubMed  Google Scholar 

  23. Hamdan AD, Malek JY, Schermerhorn ML, Aulivola B, Blattman SB, Pomposelli FB Jr (2008) Vascular injury during anterior exposure of the spine. J Vasc Surg 48:650–654

    Article  PubMed  Google Scholar 

  24. Fantini GA, Pappou IP, Girardi FP, Sandhu HS, Cammisa FP Jr (2007) Major vascular injury during anterior lumbar spinal surgery: incidence, risk factors, and management. Spine (Phila Pa 1976) 32:2751–2758

    Article  Google Scholar 

  25. Sasso RC, Best NM, Mummaneni PV, Reilly TM, Hussain SM (2005) Analysis of operative complications in a series of 471 anterior lumbar interbody fusion procedures. Spine (Phila Pa 1976) 30:670–674

    Article  Google Scholar 

  26. Quraishi NA, Konig M, Booker SJ, Shafafy M, Boszczyk BM, Grevitt MP, Mehdian H, Webb JK (2013) Access related complications in anterior lumbar surgery performed by spinal surgeons. Eur Spine J 22(Suppl 1):S16–S20

    Article  PubMed  Google Scholar 

  27. Pimenta L, Oliveira L, Schaffa T, Coutinho E, Marchi L (2011) Lumbar total disc replacement from an extreme lateral approach: clinical experience with a minimum of 2 years’ follow-up. J Neurosurg Spine 14:38–45

    Article  PubMed  Google Scholar 

  28. Oliveira L, Marchi L, Coutinho E, Pimenta L (2010) A radiographic assessment of the ability of the extreme lateral interbody fusion procedure to indirectly decompress the neural elements. Spine (Phila Pa 1976) 35:S331–S337

    Article  Google Scholar 

  29. Lund T, Oxland TR, Jost B, Cripton P, Grassmann S, Etter C, Nolte LP (1998) Interbody cage stabilisation in the lumbar spine: biomechanical evaluation of cage design, posterior instrumentation and bone density. J Bone Joint Surg Br 80:351–359

    Article  CAS  PubMed  Google Scholar 

  30. Oxland TR, Lund T (2000) Biomechanics of stand-alone cages and cages in combination with posterior fixation: a literature review. Eur Spine J 9(Suppl 1):S95–S101

    Article  PubMed  Google Scholar 

  31. Marchi L, Abdala N, Oliveira L, Amaral R, Coutinho E, Pimenta L (2012) Stand-alone lateral interbody fusion for the treatment of low-grade degenerative spondylolisthesis. Sci World J 2012:456346. doi:10.1100/2012/456346

    Article  Google Scholar 

  32. Anjarwalla NK, Morcom RK, Fraser RD (2006) Supplementary stabilization with anterior lumbar intervertebral fusion–a radiologic review. Spine (Phila Pa 1976) 31:1281–1287

    Article  Google Scholar 

  33. Fogel GR, Parikh RD, Ryu SI, Turner AW (2014) Biomechanics of lateral lumbar interbody fusion constructs with lateral and posterior plate fixation: laboratory investigation. J Neurosurg Spine 20:291–297

    Article  PubMed  Google Scholar 

  34. King D (1948) Internal fixation for lumbosacral fusion. J Bone Joint Surg Am 30A:560–565

    CAS  PubMed  Google Scholar 

  35. King D (1944) Internal fixation for lumbosacral fusion. Am J Surg 66:357–361

    Article  Google Scholar 

  36. Boucher HH (1959) A method of spinal fusion. J Bone Joint Surg Br 41:248–259

    PubMed  Google Scholar 

  37. Magerl FP (1984) Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop Relat Res 189:125–141

    PubMed  Google Scholar 

  38. Kretzer RM, Molina C, Hu N, Umekoji H, Baaj AA, Serhan H, Cunningham BW (2013) A comparative biomechanical analysis of stand alone versus facet screw and pedicle screw augmented lateral interbody arthrodesis: an in vitro human cadaveric model. J Spinal Disord Tech [Epub ahead of print]

  39. Le TV, Baaj AA, Dakwar E, Burkett CJ, Murray G, Smith DA, Uribe JS (2012) Subsidence of polyetheretherketone intervertebral cages in minimally invasive lateral retroperitoneal transpsoas lumbar interbody fusion. Spine (Phila Pa 1976) 37:1268–1273

    Article  Google Scholar 

  40. Ghahreman A, Ferch RD, Rao PJ, Bogduk N (2010) Minimal access versus open posterior lumbar interbody fusion in the treatment of spondylolisthesis. Neurosurgery 66:296–304 discussion 304

    Article  PubMed  Google Scholar 

  41. Scheufler KM, Dohmen H, Vougioukas VI (2007) Percutaneous transforaminal lumbar interbody fusion for the treatment of degenerative lumbar instability. Neurosurgery 60:203–212 discussion 212–203

    Article  PubMed  Google Scholar 

  42. Peng CW, Yue WM, Poh SY, Yeo W, Tan SB (2009) Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Spine (Phila Pa 1976) 34:1385–1389

    Article  Google Scholar 

  43. Adogwa O, Parker SL, Bydon A, Cheng J, McGirt MJ (2011) Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion: 2-year assessment of narcotic use, return to work, disability, and quality of life. J Spinal Disord Tech 24:479–484

    PubMed  Google Scholar 

Download references

Acknowledgments

The work herein has not been published elsewhere, nor is it under consideration for publication elsewhere. All authors have reviewed this work and consent to its publication. The corresponding author had access to all data and is responsible for the decision to submit this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Medstar Georgetown University Hospital, 3800 Reservoir Road, NW, PHC-7, Washington, DC, 20007, USA

    Jay W. Rhee, Rory J. Petteys, Amjad N. Anaizi, Faheem A. Sandhu & Jean-Marc Voyadzis

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  1. Jay W. Rhee
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  2. Rory J. Petteys
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  3. Amjad N. Anaizi
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  4. Faheem A. Sandhu
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Correspondence to Rory J. Petteys.

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Rhee, J.W., Petteys, R.J., Anaizi, A.N. et al. Prospective evaluation of 1-year outcomes in single-level percutaneous lumbar transfacet screw fixation in the lateral decubitus position following lateral transpsoas interbody fusion. Eur Spine J 24, 2546–2554 (2015). https://doi.org/10.1007/s00586-015-3934-x

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  • DOI: https://doi.org/10.1007/s00586-015-3934-x

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