scholarly journals Trajectory of Lumbar Translaminar Facet Screw Under Navigation: A Cadaveric Study

2020 ◽  
pp. 219256822096244
Author(s):  
Weerasak Singhatanadgige ◽  
Kittisak Songthong ◽  
Phattareeya Pholprajug ◽  
Wicharn Yingsakmongkol ◽  
Vit Kotheeranurak ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Facet Joint ◽  
Screw Fixation ◽  
Spinous Process ◽  
Transverse Process ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Cadaver Study ◽  
Lateral Angle ◽  
Starting Point ◽  
Screw Length

Study Design: Anatomic cadaver study. Objective: Translaminar facet screw fixation supplements unilateral pedicle screw-rod fixation in minimally invasive transforaminal lumbar interbody fusion (TLIF). Various screw diameters, lengths, trajectories, and insertion points are used; however, they do not represent true screw trajectory. We aimed to evaluate lumbar laminar anatomy and suggest a safe and effective insertion point and trajectory during lumbar-translaminar facet screw fixation in an anatomic cadaver study. Methods: O-arm navigation simulating the true translaminar facet screw trajectory was used to evaluate L1-S1 in cadaveric spines. The inner and outer diameters, length, and trajectory of the screw pathway were measured along the trajectory from the spinous process base through the contralateral lamina, crossing the facet joint to the transverse process base using 2 starting points: cephalad one-third (1/3SL) and one-half (1/2SL) of the spinolaminar junction. Results: Using the 1/2SL starting point, the outer and inner lamina diameters did not differ significantly from L1-L5 (7.47 ± 1.38 to 6.7 ± 1.84 mm and 4.73 ± 1.04 to 3.86 ± 1.46 mm, respectively). Screw length (36.16 ± 4.02 to 49.29 ± 10.07 mm) and lateral angle increased (50.28° ± 8.78° to 60.77° ± 8.88°), but caudal angle decreased (16.19° ± 9.01° to 1.13° ± 11.31°). Lamina diameter and screw length did not differ with different starting points. L2-L3 caudal angles were lower in the 1/2SL starting point. Conclusion: A 36- to 50-mm translaminar facet screw—with 5.0-mm diameter for L1-L2 and 4.5-mm diameter for L3-L5—can be inserted at the middle of the spinolamina, especially during minimally invasive TLIF, with a 50° to 60° lateral angle relative to the spinous process, and a caudal angle of 16° to 1° relative to the spinolamina from L1-L5.

scholarly journals Anatomic study of the lumbar lamina for safe and effective placement of lumbar translaminar facet screws

2019 ◽  
Vol 47 (10) ◽  
pp. 5082-5093
Author(s):  
Yong Hu ◽  
Bing-ke Zhu ◽  
Zhen-shan Yuan ◽  
Wei-xin Dong ◽  
Xiao-yang Sun ◽  
...  
Keyword(s):  
Facet Joint ◽  
Spinous Process ◽  
Anatomical Study ◽  
Transverse Process ◽  
Entry Point ◽  
Anatomic Study ◽  
Angle Error ◽  
Computed Tomographic ◽  
Tomographic Data ◽  
The Ideal

Objective To evaluate the anatomic characteristics of the lumbar lamina and suggest a safe and effective strategy for setting lumbar translaminar facet screws. Methods The width and length of the lumbar lamina, screw path, lateral angle of the lamina, and maximum and minimum caudal angles of the lamina from L3 to L5 were measured with Mimics software using 32 patients’ computed tomographic data. Results The optimal screw entry point was located at the median of the spinous process base or slightly lower. The ideal screw trajectory was from the entry point to the base of the transverse process and across the center of the facet joint. A length of 35 to 45 mm was suitable for L3 to L4 in most cases, and a length of 45 to 50 mm was safe for L5 in most cases. The screw should be inserted at an angle of 49.4° to 59.29° laterally and 43.68° to 57.58° caudally at L3 to L5. For the ideal caudal angle, error of <3° was considered safe. Conclusion The optimal entry point, ideal screw trajectory, ideal screw-setting angles, and safest range of the angle and length of the lumbar lamina were identified in this anatomical study.

scholarly journals Instrumentation-related complications of lumbar degenerative disc diseases treated by minimally invasive transforaminal lumbar interbody fusion

2019 ◽  
Vol 5 (3) ◽  
pp. 213-219 ◽  
Author(s):  
Xinyu Yang ◽  
Xinyu Liu
Keyword(s):  
Minimally Invasive ◽  
Neurological Deficit ◽  
Interbody Fusion ◽  
Facet Joint ◽  
Surgical Techniques ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Degenerative Disc ◽  
Percutaneous Pedicle Screw ◽  
Superior Level

Objective: To analyze the instrumentation-related complications of patients with lumbar degenerative disc diseases (LDD) who underwent minimally invasive transforaminal lumbar interbody fusion (MIS- TLIF) and to discuss the potential strategy for the control of these complications. Methods: A total of 87 patients with LDD were treated with the MIS-TLIF procedure. Complications, including malposition or breakage of guide pin, percutaneous pedicle screw (PPS) or cages, neurological deficit, and superior-level facet joint violations, were determined during and after the surgery. Computed tomography (CT) was used to evaluate the PPS accuracy and the superior-level facet joint violations. Results: A total of 386 PPSs were used. During the surgery, 3 (0.8%) guide pin and 1 (0.3%) PPS perforated the anterior wall of the vertebral body, respectively. One (0.3%) PPS was pulled out during the reduction of slip. Malposition of the cages occurred in 6 (1.6%) PPSs. These were all adjusted accordingly during the surgery. All the patients received > 2 years of follow-up. No loosening or breakage of PPS and cage was observed, but CT showed 27 (7.0%) PPSs misplaced. No neurological deficit related to misplaced PPS was observed. The total facet joint violation (FJV) rate was 36.2%, with grade 2 and grade 3 violations is 21 (12.1%) and 6 (3.4%), respectively. Conclusion: MIS-TLIF has similar instrumentation-related complications with open TLIF. Accurate preoperative evaluation and improved surgical techniques can effectively reduce these instrumentation-related complications.

Incidence of and risk factors for superior facet violation in minimally invasive versus open pedicle screw placement during transforaminal lumbar interbody fusion: a comparative analysis

2013 ◽  
Vol 18 (4) ◽  
pp. 356-361 ◽  
Author(s):  
Darryl Lau ◽  
Samuel W. Terman ◽  
Rakesh Patel ◽  
Frank La Marca ◽  
Paul Park
Keyword(s):  
Risk Factors ◽  
Minimally Invasive ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Facet Joint ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Screw Placement ◽  
Lumbar Interbody Fusion ◽  
Pedicle Screw Placement ◽  
Percutaneous Pedicle Screw

Object A reported risk factor for adjacent-segment disease is injury to the superior facet joint from pedicle screw placement. Given that the facet joint is not typically visualized during percutaneous pedicle screw insertion, there is a concern for increased facet violation (FV) in minimally invasive fusion procedures. The purpose of this study was to analyze and compare the incidence of FV among patients undergoing minimally invasive transforaminal lumbar interbody fusion (MITLIF) and open transforaminal lumbar interbody fusion (TLIF). The impact of O-arm navigation compared with traditional fluoroscopy on FV in MITLIF is also assessed, as are risk factors for FV. Methods The authors identified a consecutive population of patients who underwent MITLIF with percutaneous pedicle screw placement, as well as a matched cohort of patients who underwent open TLIF. Postoperative CT imaging was assessed to determine intraarticular FV due to pedicle screw placement. Patients were stratified into minimally invasive and open TLIF groups. Within the MITLIF group, the authors performed a subanalysis of image guidance methods used in cases of FV. Two-tailed Student t-test, ANOVA, chi-square testing, and logistic regression were used for statistical analysis. Results A total of 282 patients were identified, with a total of 564 superior pedicle screw placements. The MITLIF group consisted of 142 patients with 284 screw insertions. The open TLIF group consisted of 140 patients with 280 screw insertions. Overall, 21 (7.4%) of 282 patients experienced FV. A total of 21 screws violated a facet joint for a screw-based FV rate of 3.7% (21 of 564 screws). There were no significant differences between the MITLIF and open TLIF groups in the percentage of patients with FV (6.3% vs 8.6%) and or the percentage of screws with FV (3.2% vs 4.3%) (p = 0.475 and p = 0.484, respectively). Further stratifying the MI group into O-arm navigation and fluoroscopic guidance subgroups, the patient-based rates of FV were 10.8% (4 of 37 patients) and 4.8% (5 of 105 patients), respectively, and the screw-based rates of FV were 5.4% (4 of 74 screws) and 2.4% (5 of 210 screws), respectively. There was no significant difference between the subgroups with respect to patient-based or screw-based FV rates (p = 0.375 and p = 0.442, respectively). The O-arm group had a significantly higher body mass index (BMI) (p = 0.021). BMI greater than 29.9 was independently associated with higher FV (OR 2.36, 95% CI 1.65–8.53, p = 0.039). Conclusions The findings suggest that minimally invasive pedicle screw placement is not associated with higher rates of FV. Overall violation rates were similar in MITLIF and open TLIF. Higher BMI, however, was a risk factor for increased FV. The use of O-arm fluoroscopy with computer-assisted guidance did not significantly decrease the rate of FV.

scholarly journals Superior Facet Joint Violations during Single Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Preliminary Retrospective Clinical Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Long Jia ◽  
Yan Yu ◽  
Kamran Khan ◽  
Fuping Li ◽  
Rui Zhu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Intervertebral Disc ◽  
Interbody Fusion ◽  
Facet Joint ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Disc Height ◽  
Lumbar Interbody Fusion ◽  
Intervertebral Disc Height ◽  
Group A

Background. Facet joint violation (FV) was reported as variable iatrogenic damage that can be a crucial risk factor leading to the adjacent segment degeneration (ASD). “Blind” screw placement technique in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) contributes to the increasing incidence of FV that can be influenced by several potential factors. Many controversies about these factors and clinical outcomes of different types of FV patients exist, yet they have not been analyzed. Methods. 99 cases undergoing single-segment MIS-TLIF from July 2013 to December 2015 were retrospectively analyzed. Computed tomography (CT) was applied to determine the incidence of FV, and then the correlation between FV and relevant factors, including gender, age, body mass index (BMI), top-screw level, and decompression, was analyzed. A total of 53 cases were followed up after one year, 31 cases in noninjury (A group) and 22 patients in FV injury (B group). Results. The incidence of FV was 39. 39% (39/99) in the patients and 23.23% (46/198) in the screws. Logistic regression analysis showed that screw at L5 in patients with BMI > 30 kg/m2 was vulnerable to FV (P<0.05). Moreover, postoperative average intervertebral disc height (AIDH) of fusion segment, visual analog scale (VAS), and Oswestry disability index (ODI) scores improved significantly in group A and B when compared with preoperative data (P<0.05). Adjacent superior average intervertebral disc height (ASAIDH) presented decrease, but adjacent superior intervertebral disc Cobb angle (ASIDCA) appeared to increase in the two groups at the final follow-up compared with postoperative 3 days (P<0.05). Low back VAS and ODI scores in group A (31 cases) were lower than those in group B (22 cases) in the final follow-up (P<0.05). Conclusion. MIS-TLIF is an effective treatment for lumbar degenerative disease, but FV occurred at a higher incidence. Facet joints should be protected in MIS-TLIF to avoid FV.

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