Outcomes of posterior facet versus pedicle screw fixation of circumferential fusion: a cohort study
- 774 Downloads
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.
KeywordsFacet screw Fusion Lumbar Minimally invasive Outcomes Pedicle screw
Funded by Midwest Spine Institute Research Division and Abbott Spine.
Conflict of interest
- 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
- 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
- 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
- 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
- 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
- 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