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



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.

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Funded by Midwest Spine Institute Research Division and Abbott Spine.

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Correspondence to Glenn R. Buttermann.

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Buttermann, G.R., Thorson, T.M. & Mullin, W.J. Outcomes of posterior facet versus pedicle screw fixation of circumferential fusion: a cohort study. Eur Spine J 23, 347–355 (2014).

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  • Facet screw
  • Fusion
  • Lumbar
  • Minimally invasive
  • Outcomes
  • Pedicle screw