Rates of Upper Facet Joint Violation in Minimally Invasive Percutaneous and Open Instrumentation: A Comparative Cohort Study of Different Insertion Techniques

Abstract

Background Minimally invasive pedicle screw placement may have a higher incidence of violation of the superior cephalad unfused facet joint.

Study Aims We investigated the incidence and risk factors of upper facet joint violation in percutaneous robot-assisted instrumentation versus percutaneous fluoroscopy-guided and open transpedicular instrumentation.

Methods A retrospective study including all consecutive patients who underwent lumbar instrumentation, fusion, and decompression for spondylolisthetic stenosis and degenerative disk disease was conducted between January 2012 and January 2016. All operations were performed by the same surgeon; the patients were divided into three groups according to the method of instrumentation. Group 1 involved the robot-assisted instrumentation in 58 patients, group 2 consisted of 64 patients treated with a percutaneous transpedicular instrumentation using fluoroscopic guidance, and 72 patients in group 3 received an open midline approach for pedicle screw insertion.

Results Superior segment facet joint violation occurred in 2 patients in the robot-assisted group 1 (7%), in 22 of the percutaneous fluoroscopy-guided group 2 (34%), and in 6 cases of the open group (8%). The incidence of facet joint violation was present in 5% (3) of the screws in group 1, 22% (28) of the screws in group 2, and 3% (4) of the screws in group 3.

Conclusion Meticulous surgical planning of the appropriate entry site (Weinstein's method), trajectory planning, and proper robot-assisted instrumentation of pedicle screws reduced the risk of superior segment facet joint violation.

Keywords

upper facet joint - robot-assisted - percutaneous instrumentation - minimally invasive

• References

• 1 Archavlis E, Carvi y Nievas M. Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with high-grade facet joint osteoarthritis. Eur Spine J 2013; 22 (08) 1731-1740
• 2 Knox JB, Dai III JM, Orchowski JR. Superior segment facet joint violation and cortical violation after minimally invasive pedicle screw placement. Spine J 2011; 11 (03) 213-217
• 3 Patel RD, Graziano GP, Vanderhave KL, Patel AA, Gerling MC. Facet violation with the placement of percutaneous pedicle screws. Spine 2011; 36 (26) E1749-E1752
• 4 Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine 2004; 29 (17) 1938-1944
• 5 Jones-Quaidoo SM, Djurasovic M, Owens II RK, Carreon LY. Superior articulating facet violation: percutaneous versus open techniques. J Neurosurg Spine 2013; 18 (06) 593-597
• 6 Ohba T, Ebata S, Fujita K, Sato H, Haro H. Percutaneous pedicle screw placements: accuracy and rates of cranial facet joint violation using conventional fluoroscopy compared with intraoperative three-dimensional computed tomography computer navigation. Eur Spine J 2016; 25 (06) 1775-1780
• 7 Kantelhardt SR, Martinez R, Baerwinkel S, Burger R, Giese A, Rohde V. Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J 2011; 20 (06) 860-868
• 8 Kantelhardt SR, Keric N, Conrad J. , et al. C-OnSite ® for intraoperative 3D control of pedicular screw positions. Acta Neurochir (Wien) 2014; 156 (09) 1799-1805
• 9 Archavlis E, Carvi y Nievas M, Ulrich P. Preliminary results of minimally invasive decompression, TLIF and percutaneous pedicle screw insertion in stenotic spondylolisthesis with severe facet joint osteoarthritis. J Spine 2013; S5: 004
• 10 Weinstein JN, Rydevik BL, Rauschning W. Anatomic and technical considerations of pedicle screw fixation. Clin Orthop Relat Res 1992; (284) 34-46
• 11 Bastian L, Knop C, Lange U, Blauth M. Transpedicular implantation of screws in the thoracolumbar spine. Results of a survey of methods, frequency and complications [in German]. Orthopade 1999; 28 (08) 693-702
• 12 Pathria M, Sartoris DJ, Resnick D. Osteoarthritis of the facet joints: accuracy of oblique radiographic assessment. Radiology 1987; 164 (01) 227-230
• 13 Stieber J, Quirno M, Cunningham M, Errico TJ, Bendo JA. The reliability of computed tomography and magnetic resonance imaging grading of lumbar facet arthropathy in total disc replacement patients. Spine 2009; 34 (23) E833-E840
• 14 Babu R, Park JG, Mehta AI. , et al. Comparison of superior-level facet joint violations during open and percutaneous pedicle screw placement. Neurosurgery 2012; 71 (05) 962-970
• 15 Chung KJ, Suh SW, Swapnil K, Yang JH, Song HR. Facet joint violation during pedicle screw insertion: a cadaveric study of the adult lumbosacral spine comparing the two pedicle screw insertion techniques. Int Orthop 2007; 31 (05) 653-656
• 16 Moshirfar A, Jenis LG, Spector LR. , et al. Computed tomography evaluation of superior-segment facet-joint violation after pedicle instrumentation of the lumbar spine with a midline surgical approach. Spine 2006; 31 (22) 2624-2629
• 17 Shah RR, Mohammed S, Saifuddin A, Taylor BA. Radiologic evaluation of adjacent superior segment facet joint violation following transpedicular instrumentation of the lumbar spine. Spine 2003; 28 (03) 272-275
• 18 Chen Z, Zhao J, Xu H, Liu A, Yuan J, Wang C. Technical factors related to the incidence of adjacent superior segment facet joint violation after transpedicular instrumentation in the lumbar spine. Eur Spine J 2008; 17 (11) 1476-1480
• 19 Matsukawa K, Kato T, Yato Y. , et al. Incidence and risk factors of adjacent cranial facet joint violation following pedicle screw insertion using cortical bone trajectory technique. Spine 2016; 41 (14) E851-E856