Risk factors affected the facet joint violation during minimal invasive spinal surgery

Abstract Background Robot-assisted (RA) technique has been increasingly applied in clinical practice, providing promising outcomes of inserting accuracy and cranial facet joint protection. However, studies comparing this novel method with other assisted methods are rare, and the controversy of the superiority between the insertion techniques remains. Thus, we compare the rates and risk factors of intrapedicular accuracy and cranial facet joint violation (FJV) of RA, fluoroscopy-guided percutaneous (FP), and freehand (FH) techniques in the treatment of thoracolumbar fractures. Methods A total of 90 patients with thoracolumbar fractures requiring pedicle screw instruments were retrospectively included and divided into RA, FP, and FH groups at 1:1:1 ratio from June 2016 to May 2020. The primary outcomes were the intrapedicular accuracy and cranial FJV. The factors that affected the intrapedicular accuracy and cranial FJV were assessed using multivariate analyses.Results The optimal intrapedicular accuracy of pedicle screw placement (Grade A) in the RA, FP, and FH groups was 94.3%, 79.3%, and 88.7%, respectively. This finding indicates no significant differences between RA and FH techniques (P =0.062), but significantly higher accuracies of RA over FP (P＜0.001), and FH over FP (P= 0.013). In addition, the rates of proximal FJV in RA, FP, and FH groups were 13.9%, 29.3%, and 22.7%, respectively. The RA had a significantly greater proportion of intact facet joints than the FP (P= 0.001) and FH (P= 0.035). However, FP and FH showed significantly similar outcomes with respect to the proximal FJV (P= 0.149). The logistic regression analysis showed that FP technique (OR= 2.791), pedicle angle (OR= 0.916), and L3 insertion (OR= 0.081) were independently associated with insertion accuracy. Meanwhile, the age (OR= 0.966), pedicle angle (OR= 0.940), mild facet joint osteoarthritis (OR= 5.906), moderate facet joint osteoarthritis (OR= 5.906), severe facet joint osteoarthritis (OR= 9.991), and distance from skin to insertion point (OR= 0.575) were independently associated with cranial FJV.Conclusion RA technique showed higher rate of intrapedicular accuracy and lower rate of cranial FJV than FH and FP techniques, and it might be a safe method for pedicle screw placement in thoracolumbar surgery.

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The Rates and Risk Factors of Intra-Pedicular Accuracy and Proximal Facet Joint Violation for Single-Level Degenerative Lumbar Diseases

Spine ◽

10.1097/brs.0000000000004083 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Ren-Jie Zhang ◽

Lu-Ping Zhou ◽

Lai Zhang ◽

Hua-Qing Zhang ◽

Peng Ge ◽

...

Keyword(s):

Risk Factors ◽

Facet Joint ◽

Single Level ◽

Degenerative Lumbar Diseases ◽

Facet Joint Violation

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Rate and Risk Factors of Superior Facet Joint Violation during Cortical Bone Trajectory Screw Placement: A Comparison of Robot‐Assisted Approach with a Conventional Technique

Orthopaedic Surgery ◽

10.1111/os.12598 ◽

2019 ◽

Vol 12 (1) ◽

pp. 133-140 ◽

Cited By ~ 4

Author(s):

Xiao‐feng Le ◽

Zhan Shi ◽

Qi‐long Wang ◽

Yun‐feng Xu ◽

Jing‐wei Zhao ◽

...

Keyword(s):

Risk Factors ◽

Cortical Bone ◽

Facet Joint ◽

Conventional Technique ◽

Screw Placement ◽

Robot Assisted ◽

Cortical Bone Trajectory ◽

Facet Joint Violation

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Incidence and risk factors of facet joint violation following percutaneous kyphoplasty for osteoporotic vertebral compression fractures

Acta Radiologica ◽

10.1177/0284185118799515 ◽

2018 ◽

Vol 60 (6) ◽

pp. 755-761 ◽

Cited By ~ 1

Author(s):

Yao Li ◽

Xiangyang Wang ◽

Kaixia Jiang ◽

Jiaoxiang Chen ◽

Yan Lin ◽

...

Keyword(s):

Risk Factors ◽

Clinical Outcomes ◽

Facet Joint ◽

Multiple Logistic Regression Analysis ◽

Vertebral Compression Fractures ◽

Facet Joints ◽

Osteoporotic Vertebral Compression Fractures ◽

Compression Fractures ◽

Percutaneous Kyphoplasty ◽

Facet Joint Violation

Background Percutaneous kyphoplasty (PKP) has been widely used to osteoporotic vertebral compression fractures (OVCFs). No previous investigations have reported the incidence and risk factors of facet joint violation (FJV) caused by PKP. Purpose To determine the incidence and risk factors of FJV following PKP in patients with OVCFs. Material and Methods We reviewed a total of 153 patients who underwent bilateral PKP. Postoperative computed tomography (CT) scans were assessed to determine the degree of FJV owing to invasion by a puncture trocar. Clinical outcomes, including visual analogue scale (VAS) scores and Oswestry Disability Index (ODI) scores, were collected from all patients. Clinical and radiological data were analyzed to identify the risk factors for FJV. Results FJV caused by PKP affected 18.9% of patients and 9.6% of facet joints; approximately 3.9% and 5.7% of facet joints were considered to have grade 1 and grade 2 violations, respectively. There were significant differences between the FJV and non-FJV groups in VAS and ODI scores after surgery. Significant differences were found with respect to the facet joint angle (FJA), the pedicle diameter (PD), and the distance from the entry point to the facet joint space (DEF). Multiple logistic regression analysis indicated that an FJA > 55°, a PD < 5 mm, and a DEF < 5 mm were independent risk factors for FJV. Conclusion The placement of a puncture trocar can cause FJV in patients with OVCFs and impact clinical outcomes after PKP. Special attention should be given to patients with an FJA > 55°, a PD < 5 mm, and a DEF < 5 mm.

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Incidence and Risk Factors of Superior Facet Joint Violation in Percutaneous and Open Instrumentation Using Cortical Bone Trajectory Technique

Clinical Spine Surgery ◽

10.1097/bsd.0000000000000917 ◽

2020 ◽

Vol 33 (3) ◽

pp. E127-E134

Author(s):

Xiaofeng Le ◽

Zhan Shi ◽

Yunfeng Xu ◽

Qilong Wang ◽

Jingwei Zhao ◽

...

Keyword(s):

Risk Factors ◽

Cortical Bone ◽

Facet Joint ◽

Cortical Bone Trajectory ◽

Facet Joint Violation

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Risk Factors Related to Superior Facet Joint Violation During Lumbar Percutaneous Pedicle Screw Placement in Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF)

World Neurosurgery ◽

10.1016/j.wneu.2020.04.118 ◽

2020 ◽

Vol 139 ◽

pp. e716-e723

Author(s):

Yiwei Zhao ◽

Suomao Yuan ◽

Yonghao Tian ◽

Xinyu Liu

Keyword(s):

Risk Factors ◽

Minimally Invasive ◽

Pedicle Screw ◽

Interbody Fusion ◽

Facet Joint ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Pedicle Screw Placement ◽

Percutaneous Pedicle Screw ◽

Facet Joint Violation

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Anatomical and technical factors associated with superior facet joint violation in lumbar fusion

Journal of Neurosurgery Spine ◽

10.3171/2017.6.spine17130 ◽

2018 ◽

Vol 28 (2) ◽

pp. 173-180 ◽

Cited By ~ 8

Author(s):

Alisson R. Teles ◽

Michael Paci ◽

Gabriel Gutman ◽

Fahad H. Abduljabbar ◽

Jean A. Ouellet ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Surgical Technique ◽

Facet Joint ◽

Lumbar Fusion ◽

Screw Placement ◽

Multivariate Logistic Regression ◽

Factors Associated ◽

Facet Joint Violation ◽

Superior Level

OBJECTIVEThe aim of this study was to evaluate the anatomical and surgical risk factors for screw-related facet joint violation at the superior level in lumbar fusion.METHODSThe authors conducted a retrospective review of a consecutive series of posterior lumbar instrumented fusions performed by a single surgeon. Inclusion criteria were primary lumbar fusion of 1 or 2 levels for degenerative disorders. The following variables were analyzed as possible risk factors: surgical technique (percutaneous vs open screw placement), depth of surgical field, degree of anterior slippage of the superior level, pedicle and facet angle, and facet degeneration of the superior level. Postoperative CT scans were evaluated by 2 independent reviewers. Axial, sagittal, and coronal views were reviewed. Pedicle screws were graded as intra-articular if they clearly interposed between the superior and inferior facet joints of the superior level. Multivariate logistic regression analyses were conducted to assess the factors associated with this complication.RESULTSOne hundred thirty-one patients were included. Interobserver reliability for facet joint violation assessment was high (κ = 0.789). The incidence of superior facet joint violation was 12.59% per top-level screw (33 of 262 proximal screws). The rate of facet violation was 28.0% in the percutaneous technique group (14 of 50 patients) and 12.3% in the open surgery group (10 of 81 patients) (OR 2.26, 95% CI 1.09–4.21; p = 0.024). In multivariate logistic regression analysis, independent predictors of facet violation were percutaneous screw placement (adjusted OR 3.31, 95% CI 1.42–7.73; p = 0.006), right-side pedicle screw (adjusted OR 3.14, 95% CI 1.29–7.63; p = 0.011), and facet angle > 45° (adjusted OR 10.95, 95% CI 4.64–25.84; p < 0.0001).CONCLUSIONSThe incidence of facet joint violation was higher in percutaneous minimally invasive than in open technique for posterior lumbar spine surgery. Also, coronal orientation of the facet joint is a significant risk factor independent of the surgical technique.

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