Skip to main content
SpringerLink
Log in

Percutaneous CT-guided lumbar trans-facet pedicle screw fixation in lumbar microinstability syndrome: feasibility of a novel approach

  • Spinal Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Study design

Prospective experimental uncontrolled trial.

Background

Lumbar microinstability (MI) is a common cause of lower back pain (LBP) and is related to intervertebral disc degeneration that leads to inability to adequately absorb applied loads. The term “microinstability” has recently been introduced to denote a specific syndrome of biomechanical dysfunction with minimal anatomical change. Trans-facet fixation (TFF) is a minimally invasive technique that involves the placement of screws across the facet joint and into the pedicle, to attain improved stability in the spine.

Purpose

In this study, we aimed to evaluate the effectiveness, in terms of pain and disability reduction, of a stand-alone TFF in treatment of patients with chronic low back pain (LBP) due to MI. Moreover, as a secondary endpoint, the purpose was to assess the feasibility and safety of a novel percutaneous CT-guided technique.

Methods

We performed percutaneous CT-guided TFF in 84 consecutive patients presenting with chronic LBP attributable to MI at a single lumbar level without spondylolysis. Pre- and post-procedure pain and disability levels were measured using the visual analogue scale (VAS) and Oswestry Disability Index (ODI).

Results

At 2 years, TFF resulted in significant reductions in both VAS and ODI scores. CT-guided procedures were tolerated well by all patients under light sedation with a mean procedural time of 45 min, and there were no reported immediate or delayed procedural complications.

Conclusion

TFF seems to be a powerful technique for lumbar spine stabilization in patients with chronic mechanical LBP related to lumbar MI. CT-guided technique is fast, precise, and safe and can be performed in simple analgo-sedation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Landi et al (2015) Lumbar spinal degenerative “microinstability”: hype or hope? Proposal of a new classification to detect it and to assess surgical treatment. Eur Spine J 24(Suppl 7):S872–S878

    Article  Google Scholar 

  2. Manfrè L (2015) Spinal instability, new procedures in spine interventional neuroradiology. Springer

  3. Hancock MJ, Maher CM, Petocz P, Lin CWC, Steffens D, Luque-Suarez A, Magnussen JS (2015) Risk factors for a recurrence of low back pain. Spine J 15:2360–2368

    Article  Google Scholar 

  4. Kirkaldy-Willis WH, Farfan HF (1982) Instability of the lumbar spine. Clin Orthop Relat Res 165:110–123

    Google Scholar 

  5. Nguyen C, Poiraudeau S, Rannou F (2015) From Modic 1 vertebral-endplate subchondral bone signal changes detected by MRI to the concept of “active discopathy”. Ann Rheum Dis 74:1488–1494

    Article  Google Scholar 

  6. Gejo R, Matsui H, Kawaguchi Y, Ishihara H, Tsuji H (1999) Serial changes in trunk muscle performance after posterior lumbar surgery. Spine (Phila Pa 1976) 24(10):1023–1028

    Article  CAS  Google Scholar 

  7. Kawaguchi Y, Matsui H, Tsuji H (1996) Back muscle injury after posterior lumbar spine surgery: a histologic and enzymatic analysis. Spine (Phila Pa 1976) 21(8):941–944

    Article  CAS  Google Scholar 

  8. Taylor H, McGregor AH, Medhi-Zadeh S et al (2002) The impact of self-retaining retractors on the paraspinal muscles during posterior spinal surgery. Spine (Phila Pa 1976) 27(24):2758–2762

    Article  Google Scholar 

  9. German JW, Foley KT (2005) Minimal access surgical techniques in the management of the painful lumbar motion segment. Spine (Phi- la Pa 1976) 30(16 Suppl):S52–S59

    Article  Google Scholar 

  10. Shen FH, Samartzis D, Khanna AJ, Anderson DG (2007) Minimally invasive techniques for lumbar interbody fusions. Orthop Clin N Am 38(3):373–386 abstract vi

    Article  Google Scholar 

  11. Boucher HH (1959) A method of spinal fusion. J Bone Joint Surg Br 41-B(2):248–259

    Article  CAS  Google Scholar 

  12. Magerl FP Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop Relat Res 194(189):125–141

  13. 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(2):351–359

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

  15. Rathonyi GC, Oxland TR, Gerich U, Grass-mann S, Nolte LP (1998) The role of supplemental translaminar screws in anterior lumbar interbody fixation: a biomechanical study. Eur Spine J 7(5):400–407

    Article  CAS  Google Scholar 

  16. El Masry MA, McAllen CJ, Weatherley CR (2003) Lumbosacral fusion using the Boucher technique in combination with a posterolateral bone graft. Eur Spine J 12(4):408–412

    Article  Google Scholar 

  17. Volkman T, Horton WC, Hutton WC (1996) Transfacet screws with lumbar interbody reconstruction: biomechanical study of motion segment stiffness. J Spinal Disord 9(5):425–432

    Article  CAS  Google Scholar 

  18. Benzel EC (2001) Biomechanics of spine stabilization. Rolling Meadows, American Association of Neurological Surgeons

    Google Scholar 

  19. Cheng BC, Moore DK, Zdeblick TA et al (1997) Load-sharing characteristics of two anterior cervical plate systems. The Cervical Spine Research Society Meeting, Rancho Mirage

    Google Scholar 

  20. Pan A, Hai Y, Yang J, Zhou L, Chen X, Guo H (2016 May) Adjacent segment degeneration after lumbar spinal fusion compared with motion-preservation procedures: a meta-analysis. Eur Spine J 25(5):1522–1532. https://doi.org/10.1007/s00586-016-4415-6

    Article  PubMed  Google Scholar 

  21. Yang S, Liu Y, Bao Z, Zou J, Yang H (2017) Comparison of adjacent segment degeneration after nonrigid fixation system and posterior lumbar Interbody fusion for single-level lumbar disc herniation: a new method of MRI analysis of lumbar nucleus pulposus volume. J Investig Surg 31:307–312. https://doi.org/10.1080/08941939.2017.1325542

    Article  Google Scholar 

  22. Mahar A, Kim C, Oka R (2006) Biomechanical comparison of a novel percutaneous transfacet device and a traditional posterior system for single level fusion. J Spinal Disord Tech 19(8):591–594. https://doi.org/10.1097/01.bsd.0000211238.21835.e4

    Article  PubMed  Google Scholar 

  23. 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(12):1226–1234

    Google Scholar 

  24. 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(2):98–106

    Article  Google Scholar 

  25. Amoretti N, Amoretti ME, Hovorka I, Hauger O, Boileau P, Huwart L (2013) Percutaneous facet screw fixation of lumbar spine with CT and fluoroscopic guidance: a feasibility study. Radiology. 268(2):548–555

    Article  Google Scholar 

  26. Talia AJ, Wong ML, Lau HC, Kaye AH (2015) Comparison of the different surgical approaches for lumbar interbody fusion. J Clin Neurosci 22(2):243–251. https://doi.org/10.1016/j.jocn.2014.08.008

    Article  PubMed  Google Scholar 

  27. Xu DS, Walker CT, Godzik J, Turner JD, Smith W, Uribe JS (2018) Minimally invasive anterior, lateral, and oblique lumbar interbody fusion: a literature review. Ann Transl Med 6(6):104. https://doi.org/10.21037/atm.2018.03.24

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kuisma M, Karppinen J, Niinimäki J, Kurunlahti M, Haapea M, Vanharanta H, Tervonen O (2006) A three-year follow-up of lumbar spine endplate (Modic) changes. Spine (Phila Pa 1976) 31(15):1714–1718. https://doi.org/10.1097/01.brs.0000224167.18483.14

    Article  Google Scholar 

  29. Mitra D, Cassar-Pullicino VN, Mccall IW (2004) Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine. Eur Radiol 14(9):1574–1581. https://doi.org/10.1007/s00330-004-2314-4

    Article  CAS  PubMed  Google Scholar 

  30. Luoma K, Vehmas T, Grönblad M, Kerttula L, Kääpä E (2009) Relationship of Modic type 1 change with disc degeneration: a prospective MRI study. Skelet Radiol 38(3):237–244. https://doi.org/10.1007/s00256-008-0611-8

    Article  Google Scholar 

  31. Luoma K, Vehmas T, Grönblad M, Kerttula L, Kääpä E (2008) MRI follow-up of subchondral signal abnormalities in a selected group of chronic low back pain patients. Eur Spine J 17(10):1300–1308. https://doi.org/10.1007/s00586-008-0716-8

    Article  PubMed  PubMed Central  Google Scholar 

  32. King D (1948) Internal fixation for lumbosacral fusion. J Bone Joint Surg Am 30A(3):560–565

    Article  CAS  Google Scholar 

Download references

Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Minimal Invasive Spine Therapy Department, Mediterranean Institute for Oncology I.O.M., Viagrande, Catania, Italy

    Luigi Manfrè, Aldo Eros De Vivo, Hosam Al Qatami & Fausto Ventura

  2. Institute of Radiology, Policlinico Universitario Campus Biomedico, Rome, Italy

    Beomonte Zobel

  3. Institute of Radiology, University of Palermo, Palermo, Italy

    Massimo Midiri

  4. Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia

    Ronil V. Chandra & Nicole S. Carter

  5. Neurointerventional Radiology, Monash Imaging, Monash Health, Melbourne, Australia

    Ronil V. Chandra & Nicole S. Carter

  6. Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA

    Joshua Hirsch

Authors
  1. Luigi Manfrè
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aldo Eros De Vivo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hosam Al Qatami
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fausto Ventura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Beomonte Zobel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Massimo Midiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ronil V. Chandra
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nicole S. Carter
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Joshua Hirsch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aldo Eros De Vivo.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Manfrè, L., De Vivo, A.E., Al Qatami, H. et al. Percutaneous CT-guided lumbar trans-facet pedicle screw fixation in lumbar microinstability syndrome: feasibility of a novel approach. Neuroradiology 62, 1133–1140 (2020). https://doi.org/10.1007/s00234-020-02438-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-020-02438-4

Keywords

Search

Navigation