European Spine Journal

, Volume 23, Issue 2, pp 347–355 | Cite as

Outcomes of posterior facet versus pedicle screw fixation of circumferential fusion: a cohort study

  • Glenn R. ButtermannEmail author
  • Tague M. Thorson
  • William J. Mullin
Original Article



To compare single-level circumferential spinal fusion using pedicle (n = 27) versus low-profile minimally invasive facet screw (n = 35) posterior instrumentation.


A prospective two-arm cohort study with 5-year outcomes as follow-up was conducted. Assessment included back and leg pain, pain drawing, Oswestry disability index (ODI), pain medication usage, self-assessment of procedure success, and >1-year postoperative lumbar magnetic resonance imaging.


Significantly less operative time, estimated blood loss and costs were incurred for the facet group. Clinical improvement was significant for both groups (p < 0.01 for all outcomes scales). Outcomes were significantly better for back pain and ODI for the facet relative to the pedicle group at follow-up periods >1 year (p < 0.05). Postoperative magnetic resonance imaging found that 20 % had progressive adjacent disc degeneration, and posterior muscle changes tended to be greater for the pedicle screw group.


One-level circumferential spinal fusion using facet screws proved superior to pedicle screw instrumentation.


Facet screw Fusion Lumbar Minimally invasive Outcomes Pedicle screw 



Funded by Midwest Spine Institute Research Division and Abbott Spine.

Conflict of interest



  1. 1.
    Hsieh PC, Koski TR, O’Shaughnessy BA, Sugrue P, Salehi S, Ondra S, Liu JC (2007) Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance. J Neurosurg Spine 7(4):379–386PubMedCrossRefGoogle Scholar
  2. 2.
    Min JH, Jang JS, Jung BJ, Lee HY, Choi WC, Shim CS, Choi G, Lee SH (2008) The clinical characteristics and risk factors for the adjacent segment degeneration in instrumented lumbar fusion. J Spinal Disord Tech 21(5):305–309PubMedCrossRefGoogle Scholar
  3. 3.
    Mura PP, Costaglioli M, Piredda M, Caboni S, Casula S (2011) TLIF for symptomatic disc degeneration: a retrospective study of 100 patients. Eur Spine J 20(Suppl 1):S57–S60PubMedCrossRefGoogle Scholar
  4. 4.
    Freeman BJ, Licina P, Mehdian SH (2000) Posterior lumbar interbody fusion combined with instrumented postero-lateral fusion: 5-year results in 60 patients. Eur Spine J 9(1):42–46PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Høy K, Bünger C, Niederman B, Helmig P, Hansen ES, Li H, Andersen T (2013) Transforaminal lumbar interbody fusion (TLIF) versus posterolateral instrumented fusion (PLF) in degenerative lumbar disorders: a randomized clinical trial with 2-year follow-up. Eur Spine J 22(9):2022–2029Google Scholar
  6. 6.
    Krishna M, Pollock RD, Bhatia C (2008) Incidence, etiology, classification, and management of neuralgia after posterior lumbar interbody fusion surgery in 226 patients. Spine J 8(2):374–379PubMedCrossRefGoogle Scholar
  7. 7.
    Rantanen J, Hurme M, Falck B, Alaranta H, Nykvist F, Lehto M, Einola S, Kalimo H (1993) The lumbar multifidus muscle five years after surgery for a lumbar intervertebral disc herniation. Spine 18(5):568–574PubMedCrossRefGoogle Scholar
  8. 8.
    Taylor H, McGregor AH, Medhi-Zadeh S, Richards S, Kahn N, Zadeh JA, Hughes SP (2002) The impact of self-retaining retractors on the paraspinal muscles during posterior spinal surgery. Spine 27(24):2758–5862PubMedCrossRefGoogle Scholar
  9. 9.
    Kim KT, Lee SH, Suk KS, Bae SC (2006) The quantitative analysis of tissue injury markers after mini-open lumbar fusion. Spine 31(6):712–716PubMedCrossRefGoogle Scholar
  10. 10.
    Kikuchi Y, Nakamura T, Takayama S, Horiuchi Y, Toyama Y (2003) MR imaging in the diagnosis of denervated and reinnervated skeletal muscles: experimental study in rats. Radiology 229(3):861–867PubMedCrossRefGoogle Scholar
  11. 11.
    Gejo R, Kawaguchi Y, Kondoh T, Tabuchi E, Matsui H, Torii K, Ono T, Kimura T (2000) Magnetic resonance imaging and histologic evidence of postoperative back muscle injury in rats. Spine 258:941–946CrossRefGoogle Scholar
  12. 12.
    Remes V, Lamberg T, Tervahartiala P, Helenius I, Schlenzka D, Yrjönen T, Osterman K, Seitsalo S, Poussa M (2006) Long-term outcome after posterolateral, anterior, and circumferential fusion for high-grade isthmic spondylolisthesis in children and adolescents. Magnetic resonance imaging findings after average of 17-year follow-up. Spine 31(21):2491–2499PubMedCrossRefGoogle Scholar
  13. 13.
    Gille O, Jolivet E, Dousset V, Degrise C, Obeid I, Vital JM, Skalli W (2007) Erector spinae muscle changes on magnetic resonance imaging following lumbar surgery through a posterior approach. Spine 32(11):1236–1241PubMedCrossRefGoogle Scholar
  14. 14.
    Kamath S, Venkatanarasimha N, Walsh MA, Hughes PM (2008) MRI appearance of muscle denervation. Skeletal Radiol 37(5):397–404PubMedCrossRefGoogle Scholar
  15. 15.
    Gejo R, Matsui H, Kawaguchi Y, Ishihara H, Tsuji H (1999) Serial changes in trunk muscle performance after posterior lumbar surgery. Spine 24(10):1023–1028PubMedCrossRefGoogle Scholar
  16. 16.
    Aepli M, Mannion AF, Grob D (2009) Translaminar screw fixation of the lumbar spine: long-term outcome. Spine 34(14):1492–1498PubMedCrossRefGoogle Scholar
  17. 17.
    Best NM, Sasso RC (2006) Efficacy of translaminar facet screw fixation in circumferential interbody fusions as compared to pedicle screw fixation. J Spinal Disord Tech 19(2):98–103PubMedCrossRefGoogle Scholar
  18. 18.
    Beaubien BP, Mehbod AA, Kallemeier PM, Lew WD, Buttermann GR, Transfeldt EE, Wood KB (2004) Posterior augmentation of an anterior lumbar interbody fusion: minimally invasive fixation versus pedicle screws in vitro. Spine 29(19):E406–E412PubMedCrossRefGoogle Scholar
  19. 19.
    Burton D, McIff T, Fox T, Lark R, Asher MA, Glattes RC (2005) Biomechanical analysis of posterior fixation techniques in a 360 degrees arthrodesis model. Spine 30:2765–2771PubMedCrossRefGoogle Scholar
  20. 20.
    Razi AE, Spivak JM, Kummer FJ, Hersh DS, Goldstein JA (2011) Biomechanical comparison of translaminar screw versus pedicle screw supplementation of anterior femoral ring allografts in one-level lumbar spine fusion. Bull NYU Hosp J Dis 69(4):298–302Google Scholar
  21. 21.
    Kim DY, Lee SH, Chung SK, Lee HY (2004) Comparison of multifidus muscle atrophy and trunk extension muscle strength. Spine 30:123–129CrossRefGoogle Scholar
  22. 22.
    Lee JC, Cha J-G, Kim Y, Kim Y-I, Shin B-J (2008) Quantitative analysis of back muscle degeneration in the patients with the degenerative lumbar flat back using a digital image analysis: comparison with the normal controls. Spine 33(3):318–325PubMedCrossRefGoogle Scholar
  23. 23.
    Battié MC, Niemelainen R, Gibbons LE, Dhillon S (2012) Is level- and side-specific multifidus asymmetry a marker for lumbar disc pathology? Spine J 12(10):932–939PubMedCrossRefGoogle Scholar
  24. 24.
    Zigler J, Delamarter R, Spivak JM, Linovitz RJ, Danielson GO 3rd, Haider TT, Cammisa F, Zuchermann J, Balderston R, Kitchel S, Foley K, Watkins R, Bradford D, Yue J, Yuan H, Herkowitz H, Geiger D, Bendo J, Peppers T, Sachs B, Girardi F, Kropf M, Goldstein J (2007) Results of the prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential fusion for the treatment of 1-level degenerative disc disease. Spine 32(11):1155–1162PubMedCrossRefGoogle Scholar
  25. 25.
    Glassman S, Gornet MF, Branch C, Polly D Jr, Peloza J, Schwender JD, Carreon L (2006) MOS short form 36 and Oswestry Disability Index outcomes in lumbar fusion: a multicenter experience. Spine J 6(1):21–26PubMedCrossRefGoogle Scholar
  26. 26.
    Jang JS, Lee SH (2005) Clinical analysis of percutaneous facet screw fixation after anterior lumbar interbody fusion. J Neurosurg Spine 3(1):40–46PubMedCrossRefGoogle Scholar
  27. 27.
    Tuli S, Eichler ME, Woodard EJ (2005) Comparison of perioperative morbidity in translaminar facet versus pedicle screw fixation. Orthopedics 28(8):773–778PubMedGoogle Scholar
  28. 28.
    Tuli J, Tuli S, Eichler ME, Woodard EJ (2007) A comparison of long-term outcomes of translaminar facet screw fixation and pedicle screw fixation: a prospective study. J Neurosurg Spine 7(3):287–292PubMedCrossRefGoogle Scholar
  29. 29.
    Carragee EJ, Don AS, Hurwitz EL, Cuellar JM, Carrino JA, Herzog R (2009) Does discography cause accelerated progression of degeneration changes in the lumbar disc: a ten-year matched cohort study. Spine 34(21):2338–2345PubMedCrossRefGoogle Scholar
  30. 30.
    Fan SW, Hu ZJ, Fang XQ, Zhao FD, Huang Y, Yu HJ (2010) Comparison of paraspinal muscle injury in one-level lumbar posterior inter-body fusion: modified minimally invasive and traditional open approaches. Orthop Surg 2(3):194–200PubMedCrossRefGoogle Scholar
  31. 31.
    Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, Mummaneni P, Watters WC 3rd, Wang J, Walters BC, Hadley MN, American Association of Neurological Surgeons/Congress of Neurological Surgeons (2005) Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 11: interbody techniques for lumbar fusion. J Neurosurg Spine 2(6):692–699PubMedCrossRefGoogle Scholar
  32. 32.
    Bendix T, Sorensen JS, Henriksson GA, Bolstad JE, Narvestad EK, Jensen TS (2012) Lumbar modic changes—a comparison between findings at low- and high-field magnetic resonance imaging. Spine 37(20):1756–1762PubMedCrossRefGoogle Scholar
  33. 33.
    Habib A, Smith ZA, Lawton CD, Fessler RG (2012) Minimally invasive transforaminal lumbar interbody fusion: a perspective on current evidence and clinical knowledge. Minim Invasive Surg 1:1–9CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Glenn R. Buttermann
    • 1
    Email author
  • Tague M. Thorson
    • 3
  • William J. Mullin
    • 2
  1. 1.Midwest Spine InstituteStillwaterUSA
  2. 2.Center for Diagnostic ImagingMinneapolisUSA
  3. 3.University of UtahSalt Lake CityUSA

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