20. Biomechanical effect of facet joint violation on adjacent segment motion and disc strain following single level lumbar fusion with transpedicular screw and rod instrumentation

Abstract BACKGROUND: Superior-level facet joint violation by pedicle screws may result in increased stress to the level above the instrumentation and may contribute to adjacent segment disease. Previous studies have evaluated facet joint violations in open or percutaneous screw cases, but there are no reports describing a direct institutional comparison. OBJECTIVE: To compare the incidence of superior-level facet violation for open vs percutaneous pedicle screws and to evaluate patient and surgical factors that affect this outcome. METHODS: We reviewed 279 consecutive patients who underwent an index instrumented lumbar fusion from 2007 to 2011 for degenerative spine disease with stenosis with or without spondylolisthesis. We used a computed tomography grading system that represents progressively increasing grades of facet joint violation. Patient and surgical factors were evaluated to determine their impact on facet violation. RESULTS: Our cohort consisted of 126 open and 153 percutaneous cases. Percutaneous procedures had a higher overall violation grade (P = .02) and a greater incidence of high-grade violations (P = .006) compared with open procedures. Bivariate analysis showed significantly greater violations in percutaneous cases for age < 65 years, obesity, pedicle screws at L4, and 1- and 2-level surgeries. Multivariate analysis showed the percutaneous approach and depth of the spine to be independent risk factors for high-grade violations. CONCLUSION: This study demonstrates greater facet violations for percutaneously placed pedicle screws compared with open screws.

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The Relationship between Adjacent Segment Pathology and Facet Joint Violation by Pedicle Screw after Posterior Lumbar Instrumentation Surgery

Journal of Clinical Medicine ◽

10.3390/jcm10132911 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2911

Author(s):

Ho-Seok Oh ◽

Hyoung-Yeon Seo

Keyword(s):

Pedicle Screw ◽

Scoring System ◽

Facet Joint ◽

Adjacent Segment ◽

Type I ◽

Type Ii ◽

Type Iii ◽

Transpedicular Screw ◽

Facet Joint Violation ◽

The Relationship

Transpedicular screw instrumentation systems have been increasingly utilized during the fusion of lumbar spine procedures. The superior segment facet joint violation of the pedicle screw is thought to have potential for accelerating symptomatic adjacent-segment pathology (ASP). The purpose of this study was to investigate the relationship between the superior segment facet joint violation by transpedicular screws and the development of ASP. Among all patients who underwent operations involving one- or two-level posterior lumbar arthrodesis at the Chonnam National University Hospital from 1992 to 2012, 87 patients were selected for this study. Fifty-six patients were included in the ASP group, and 31 were included in the non-ASP group. We used lumbar three-dimensional computed tomography (CT) to assess the violation of the superior facet joint by a transpedicular screw. The assessment is presented in scores ranging from zero to two, with zero indicating no violation (type I); one point indicating suspected violation (type II); and two points indicating definitely facet joint violation (type III). Facet violation was reported in 31 patients in the ASP group (n = 56), and in 13 patients in the non-ASP group (n = 31). The types of facet joint violation according to our scoring system were as follows: type I, 59 screws (52.7%); type II, 26 screws (23.2%); and type III, 27 screws (24.1%) in the ASP group; and type I, 43 screws (69.4%), type II, 14 screws (22.6 %); and type III, 5 screws (8.0%) in the non-ASP group. The score of facet joint violation in each patient according to our scoring system were as follows: 0 points, 25 patients (44.6%); 1 point, 8 patients (14.3%); 2 points, 4 patients (7.1%); 3 points, 11 patients (19.7%); 4 points, 8 patients (14.3%) in the ASP group; and 0 points, 18 patients (58.1%); 1 point, 4 patients (12.9%); 2 points, 7 patients (22.6%); 3 points, 2 patients (6.4%); 4 points, 0 patients (0%) in the non-ASP group. The mean scores were 1.4 points in the ASP group and 0.8 points in the non-ASP group (p < 0.05). We conclude that the position of the pedicle screw farther away from the facet joint surface can reduce the degeneration of the superior adjacent segment. Therefore, close attention to the screw position during surgery may reduce the rate of superior adjacent-segment pathologies.

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The biomechanical effect on the adjacent L4/L5 segment of S1 superior facet arthroplasty: a finite element analysis for the male spine

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02540-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zewen Shi ◽

Lin Shi ◽

Xianjun Chen ◽

Jiangtao Liu ◽

Haihao Wu ◽

...

Keyword(s):

Finite Element ◽

Range Of Motion ◽

Facet Joint ◽

Adjacent Segment ◽

Finite Element Models ◽

Level Of Evidence ◽

Element Analysis ◽

Flexion Extension ◽

Biomechanical Effect ◽

Lumbar Range Of Motion

Abstract Background The superior facet arthroplasty is important for intervertebral foramen microscopy. To our knowledge, there is no study about the postoperative biomechanics of adjacent L4/L5 segments after different methods of S1 superior facet arthroplasty. To evaluate the effect of S1 superior facet arthroplasty on lumbar range of motion and disc stress of adjacent segment (L4/L5) under the intervertebral foraminoplasty. Methods Eight finite element models (FEMs) of lumbosacral vertebrae (L4/S) had been established and validated. The S1 superior facet arthroplasty was simulated with different methods. Then, the models were imported into Nastran software after optimization; 500 N preload was imposed on the L4 superior endplate, and 10 N⋅m was given to simulate flexion, extension, lateral flexion and rotation. The range of motion (ROM) and intervertebral disc stress of the L4-L5 spine were recorded. Results The ROM and disc stress of L4/L5 increased with the increasing of the proportions of S1 superior facet arthroplasty. Compared with the normal model, the ROM of L4/L5 significantly increased in most directions of motion when S1 superior facet formed greater than 3/5 from the ventral to the dorsal or 2/5 from the apex to the base. The disc stress of L4/L5 significantly increased in most directions of motion when S1 superior facet formed greater than 3/5 from the ventral to the dorsal or 1/5 from the apex to the base. Conclusion In this study, the ROM and disc stress of L4/L5 were affected by the unilateral S1 superior facet arthroplasty. It is suggested that the forming range from the ventral to the dorsal should be less than 3/5 of the S1 upper facet joint. It is not recommended to form from apex to base. Level of evidence Level IV

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Biomechanical effect of interspinous dynamic stabilization adjacent to single-level fusion on range of motion of the transition segment and the adjacent segment

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2015.02.012 ◽

2015 ◽

Vol 30 (4) ◽

pp. 355-359 ◽

Cited By ~ 5

Author(s):

Chao Kong ◽

Shibao Lu ◽

Yong Hai ◽

Lei Zang

Keyword(s):

Range Of Motion ◽

Dynamic Stabilization ◽

Adjacent Segment ◽

Single Level ◽

Biomechanical Effect ◽

Level Fusion

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Adjacent-segment effects of lumbar cortical screw–rod fixation versus pedicle screw–rod fixation with and without interbody support

Journal of Neurosurgery Spine ◽

10.3171/2020.11.spine20977 ◽

2021 ◽

pp. 1-7

Author(s):

Piyanat Wangsawatwong ◽

Anna G. U. Sawa ◽

Bernardo de Andrada Pereira ◽

Jennifer N. Lehrman ◽

Luke K. O’Neill ◽

...

Keyword(s):

Pedicle Screw ◽

Interbody Fusion ◽

Lumbar Fusion ◽

Statistical Significance ◽

Adjacent Segment ◽

Lumbar Interbody Fusion ◽

Lateral Bending ◽

Single Level ◽

Cortical Screw ◽

Flexion Extension

OBJECTIVE Cortical screw–rod (CSR) fixation has emerged as an alternative to the traditional pedicle screw–rod (PSR) fixation for posterior lumbar fixation. Previous studies have concluded that CSR provides the same stability in cadaveric specimens as PSR and is comparable in clinical outcomes. However, recent clinical studies reported a lower incidence of radiographic and symptomatic adjacent-segment degeneration with CSR. No biomechanical study to date has focused on how the adjacent-segment mobility of these two constructs compares. This study aimed to investigate adjacent-segment mobility of CSR and PSR fixation, with and without interbody support (lateral lumbar interbody fusion [LLIF] or transforaminal lumbar interbody fusion [TLIF]). METHODS A retroactive analysis was done using normalized range of motion (ROM) data at levels adjacent to single-level (L3–4) bilateral screw–rod fixation using pedicle or cortical screws, with and without LLIF or TLIF. Intact and instrumented specimens (n = 28, all L2–5) were tested using pure moment loads (7.5 Nm) in flexion, extension, lateral bending, and axial rotation. Adjacent-segment ROM data were normalized to intact ROM data. Statistical comparisons of adjacent-segment normalized ROM between two of the groups (PSR followed by PSR+TLIF [n = 7] and CSR followed by CSR+TLIF [n = 7]) were performed using 2-way ANOVA with replication. Statistical comparisons among four of the groups (PSR+TLIF [n = 7], PSR+LLIF [n = 7], CSR+TLIF [n = 7], and CSR+LLIF [n = 7]) were made using 2-way ANOVA without replication. Statistical significance was set at p < 0.05. RESULTS Proximal adjacent-segment normalized ROM was significantly larger with PSR than CSR during flexion-extension regardless of TLIF (p = 0.02), or with either TLIF or LLIF (p = 0.04). During lateral bending with TLIF, the distal adjacent-segment normalized ROM was significantly larger with PSR than CSR (p < 0.001). Moreover, regardless of the types of screw-rod fixations (CSR or PSR), TLIF had a significantly larger normalized ROM than LLIF in all directions at both proximal and distal adjacent segments (p ≤ 0.04). CONCLUSIONS The use of PSR versus CSR during single-level lumbar fusion can significantly affect mobility at the adjacent segment, regardless of the presence of TLIF or with either TLIF or LLIF. Moreover, the type of interbody support also had a significant effect on adjacent-segment mobility.

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Superior Segment Facet Joint Violation During Instrumented Lumbar Fusion is Associated With Higher Reoperation Rates and Diminished Improvement in Quality of Life

Clinical Spine Surgery ◽

10.1097/bsd.0000000000000566 ◽

2018 ◽

Vol 31 (1) ◽

pp. E36-E41 ◽

Cited By ~ 13

Author(s):

Jay M. Levin ◽

Vincent J. Alentado ◽

Andrew T. Healy ◽

Michael P. Steinmetz ◽

Edward C. Benzel ◽

...

Keyword(s):

Quality Of Life ◽

Facet Joint ◽

Lumbar Fusion ◽

Facet Joint Violation ◽

Reoperation Rates

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Paraspinal muscle, facet joint, and disc problems: risk factors for adjacent segment degeneration after lumbar fusion

The Spine Journal ◽

10.1016/j.spinee.2016.03.010 ◽

2016 ◽

Vol 16 (7) ◽

pp. 867-875 ◽

Cited By ~ 29

Author(s):

Jong Yeol Kim ◽

Dal Sung Ryu ◽

Ho Kyu Paik ◽

Sang Soak Ahn ◽

Moo Sung Kang ◽

...

Keyword(s):

Risk Factors ◽

Facet Joint ◽

Lumbar Fusion ◽

Adjacent Segment Degeneration ◽

Paraspinal Muscle ◽

Adjacent Segment

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Protective effects of preserving the posterior complex on the development of adjacent-segment degeneration after lumbar fusion

Journal of Neurosurgery Spine ◽

10.3171/2013.5.spine12650 ◽

2013 ◽

Vol 19 (2) ◽

pp. 201-206 ◽

Cited By ~ 14

Author(s):

Haichun Liu ◽

Wenliang Wu ◽

Yi Li ◽

Jinwei Liu ◽

Kaiyun Yang ◽

...

Keyword(s):

Lumbar Lordosis ◽

Facet Joint ◽

Lumbar Fusion ◽

Adjacent Segment Degeneration ◽

The Other ◽

Disc Height ◽

Adjacent Segment ◽

Number Of Patients ◽

Group A

Object During the past decades, lumbar fusion has increasingly become a standard treatment for degenerative spinal disorders. However, it has also been associated with an increased incidence of adjacent-segment degeneration (ASD). Previous studies have reported less ASD in anterior fusion surgeries; thus, the authors hypothesized that the integrity of the posterior complex plays an important role in ASD. This study was designed to investigate the effect of the posterior complex on adjacent instability after lumbar instrumentation and the development of ASD. Methods To evaluate different surgical interventions, 120 patients were randomly allocated into 3 groups of 40 patients each who were statistically similar with respect to demographic and clinical data. Patients in Group A were allocated for facet joint resection and L4–5 fusion, Group B for semilaminectomy and fusion, and Group C for complete laminectomy and fusion. All of the patients were followed up for 5–7 years (mean 5.9 years). The disc height, intervertebral disc angle, dynamic intervertebral angular range of motion (ROM), L3–4 slip, and the total lordosis angle were each measured before the operation and at the final follow-up. The Japanese Orthopaedic Association (JOA) score was determined before surgery and at the final follow-up to evaluate the clinical results. Results Among the 3 groups, no significant differences were detected in all clinical and demographic assessments before surgery. At 3 months after surgery, the JOA score of all groups improved significantly and showed no significant differences among the groups. At the final follow-up, Group C had a significantly (p < 0.05) lower JOA score than the other 2 groups. Moreover, the disc height and total lumbar lordosis in patients of Group C were significantly decreased compared with disc height and total lumbar lordosis in the other 2 groups. In contrast, disc angle, dynamic angular ROM, and listhesis were significantly higher in Group C than in the other 2 groups. Twenty-four patients showed signs of ASD after the operation (3 patients in Group A, 4 in B, and 17 in C). The number of patients in Group C showing ASD was significantly different from that in Groups A and B. Conclusions During follow-up for 6 years, a significantly higher number of patients with ASD were noted in the complete-laminectomy group. The number of reoperations for treating ASD was much higher in this patient group than in the patients undergoing facet joint resection and L4–5 fusion or semilaminectomy and fusion. Therefore, preserving the posterior complex as much as possible during surgery plays an important role in preventing ASD and in reducing the reoperation rate.

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