Evaluation of Trans-laminar Facet Screw for Lumbar Spine Fixation and Fusion: A Systematic Review

Background Translaminar facet screws are an excellent solution for stabilization of the vertebral motion. It is simple, does not require any specialized equipment, and has the advantages of being a procedure of lesser magnitude, lesser operative time and few complication rate. Recently there is growing interest in this technique to augment the anterior lumbar fusions to achieve global fusion less invasively. Aim of the Work to evaluate the role of translaminar facet screw in lumber fixation and fusion inclusion different techniques of translaminar facet screw fixation, its advantages and disadvantages. Methodology: This systematic review included a discussion of all available studies meeting the eligible criteria including: well conducted descriptive studies, cohort, articles, accepted manuscripts, clinical trials, analytic studies and the literature of reviews, technical notes. Results The small volume of the metal in comparison with pedicle screw constructs provides faster patient recovery and reduce the rate of infection and also provide an adequate area for placement of bone grafts. The low cost of the implants is an added advantage in view of the rising costs of health care. Conclusion Translaminar facet screw fixation is feasible, cheaper and effective in lumbar fixation. The technique is not demanding as transpedicular screw with easier learning curve.

Pulmonary cement embolism following transpedicular screws placement for thoracolumbar fractures

Background: Symptomatic pulmonary cement embolism in patients undergoing thoracic transpedicular fenestrated screw placement is rare. Here, we have added a 64-year-old female undergoing transpedicular screw placement for a T11 fracture who developed a pulmonary cement embolism intraoperatively and add this case to 13 others identified in the literature. Case Description: A 64-year-old female presented with a type “C”, ASIA “E” T11 fracture. The thoracolumbar pedicle screw fixation was supplemented with bone cement due to her underlying severe osteoporosis. During the fluoroscopy-guided supplementation with bone cement, a leak through the paravertebral venous system was noted. Thirty minutes later, the patient acutely developed extreme respiratory failure and required mechanical ventilation for the next 2 days. The diagnosis of pulmonary embolism due to bone cement was confirmed on a contrast computed tomography study of the chest. Conclusion: Symptomatic pulmonary cement embolization supplementing transpedicular screws placement for osteoporotic bone is rare. Here, we present a 64-year-old female who during transpedicular fixation of a T11 fracture developed an acute pulmonary embolism from the bone cement resulting in the need for 2 days of postoperative artificial ventilation.

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

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.

Rotational stability of thoracolumbar junction fixation systems

Objective To compare the rotational stability of fusion constructs using bisegmental fixation of Th12-L2 vertebrae with anterior stabilization or pedicle screw fixation.Material and Methods The strength, rigidity and limit of elasticity in the “injured vertebral motion segments (VMS) – bisegmental anterior stabilization” system under dislocating rotational loads were estimated. The data obtained were compared with the similar characteristics of the “injured VMS – bisegmental 4-screw transpedicular metal construction” system and intact spine segments.Results Under rotational loads the limits of elasticity of injured spine segments of Th12-L2 with anterior stabilization and transpedicular screw fixation (TSF) is 45.5 and 41.7%, respectively, and the general strength is 66.4% and 80%, respectively, as compared with those intact VMS. Rigidity parameters of anterior-stabilized and pedicle screw fixated VMS with unstable damage of L1 are 60.2 and 93.9%, accordingly, in comparison with those intact VMS.Conclusion No significant differences were observed between bisegmental anterior stabilization and bisegmental pedicle screw fixation of thoracolumbar junction in terms of the key mechanical properties. When treating patients with unstable thoracolumbar spine injuries using bisegmental anterior stabilization or transpedicular fixation with 4-screw spinal system possible rotation motion amplitude of operated segments must not exceed 50% of maximum physiological limits.

Clinical effect of a novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for thoracolumbar burst fractures

Background Short-segment transpedicular screw fixation is a common method for the treatment of thoracolumbar burst fractures (TBFs),but this technique has many problems. Therefore,the purpose of this article is to observe and evaluate the clinical efficacy of a novel transpedicular reducer that we designed for fractured vertebral body reduction and bone grafting in the treatment of TBFs. Methods From July 2018 to November 2020, 70 cases of TBFs were included. Thirty-five patients were treated with the novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation (observation group), and 35 patients were treated with short-segment transpedicular screw fixation (control group). Before the operation, after reduction, and 3 days, 3 months,and 12 months after the operation, the two groups were assessed, and compared with respect to the anterior and middle heights of the injured vertebrae, the ratios of the anterior and middle heights of the injured vertebral body to the respective heights of the adjacent uninjured vertebral bodies (AVBHr and MVBHr, respectively), and the Cobb angle of the patients. We compared the pain VAS score and quality of life GQOL-74 score at the last follow-up. Finally,we evaluated the distribution of bone grafts and bone healing 12 months after the operation. Results The anterior height, middle height, AVBHr, MVBHr, and Cobb angle of the injured vertebral body in the observation after reduction, and 3 days, 3 months and 12 months post-operatively were compared with those of the injured vertebral body before operation. All of these parameters were improved, and the difference was statistically significant (p < 0.05). These parameters in the observation group at the above time points were significantly better than thoes in the control group at the corresponding time points (p < 0.05). The VAS scores at the last follow-up were significantly better than those of the control group (p < 0.05), but the GQOL-74 score differences were not statistically significant (p > 0.05). The observation group showed no obvious defects on CT at 12 months after the operation, and the bone healing was good. Conclusion The novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for TBFs has good clinical efficacy.

Transpedicular fixation of the spine with two-level navigation templates for narrow pedicles

Objective. To assess the correctness of transpedicular screw insertion in thoracic and lumbar vertebrae using two-level navigation templates for narrow pedicles.Material and Methods. Two-level navigation templates were used in surgical treatment of four patients aged 14–17 years with scoliotic deformity and multiple pedicles of small width (less than 4.35 mm). In each patient, the least favorable zones were selected for implantation using navigation templates. The rest of planned pedicle screws were inserted using free-hand technique. All patients underwent CT scanning postoperatively. Screws inserted to pedicles less than 4.35 mm in width were classified as correctly placed if they did not extend beyond the medial cortical layer by more than 2 mm.Results. Out of 68 pedicles planned for screw placement, 42 were narrower than 4.35 mm. In the pedicles difficult for implantation, 29 screws were inserted using navigation templates and 13 by free-hand technique. Screws classified as correctly placed were 28 from those inserted with navigation templates and 9 from those implanted by free-hand technique. Difference in results of screw placement in narrow pedicles with navigation templates and by free-hand technique was statistically significant (exact Fisher test, p < 0.05).Conclusion. Transpedicular screw placement with two-level navigation templates in narrow pedicles is more correct than insertion by free hand technique.

Surgical outcomes of decompression alone versus transpedicular screw fixation for upper lumbar disc herniation

Background Surgical outcomes of upper lumbar disc herniations (ULDHs) including T12-L1, L1-L2, and L2-L3 levels are characteristically less favorable and more unpredictable. Objectives This study was conducted to compare the surgical outcomes of decompression alone versus decompression combined with transpedicular screw fixation in treating upper lumbar disc herniation. Methods This retrospective cohort study was carried out at Neurosurgery Departments, Tanta University. The study included 46 patients with a symptomatic high lumbar herniated disc at T12-L1, L1-L2, and L2-L3 levels. The enrolled patients were divided into two groups depending on whether they were operated on via decompression and partial medial facetectomy (group 1, 22 patients) or via the previous maneuver plus transpedicular screw fixation (group 2, 24 patients). All patients were medically evaluated immediately after the operation; then, they were followed up at the 3rd and the 6th months following surgery. Patients’ outcomes were assessed by visual analogue score (VAS) and Oswestry Disability Index (ODI) scores. Results Median VAS scores in each group revealed significant reduction immediately following surgery and at each of 7 days, 3 months, and 6 months in comparison with the preoperative VAS score (p<0.001). Furthermore, each group showed significant stepwise reduction in the median ODI score at the 3rd and the 6th months postoperative compared to the preoperative ODI score (group 1 = 68.0, 19.0, 15.0; p< 0.001 and group 2 = 66.5, 20.0, 15.0; p< 0.001), with no significant differences between both groups (p> 0.05). Conclusions Both standalone decompression and decompression combined with transpedicular screw fixation revealed comparable favorable outcomes in patients with ULDH.

Hidden blood loss and its influencing factors after minimally invasive percutaneous transpedicular screw fixation in thoracolumbar fracture

Objective: This study aimed to investigate the amount of hidden blood loss (HBL) and its influencing factors after minimally invasive percutaneous transpedicular screw fixation (MIPTSF) in thoracolumbar fracture.Summary of Background Data: MIPTSF is generally accepted as a minimally invasive treatment for thoracolumbar fracture. However, HBL caused by this procedure is usually disregarded.Materials and Methods: Between October 2017 and December 2020, a total of 146 patients (106 males and 40 females, age range 21–59 years) were retrospectively examined, and their clinical and radiological data were recorded and analyzed. The Pearson or Spearman correlation analysis was used to investigate an association between patient’s characteristics and HBL. Multivariate linear regression analysis was performed to elucidate the related clinical or radiological factors of HBL.Results: A substantial amount of HBL (164.00 ±112.02 ml, 40.65% of TBL) occurred after transpedicular screw internal fixation. Multivariate linear regression analysis revealed that HBL was positively associated with total blood loss (TBL) (P=.000), percentage of vertebral height loss (VHL) (P=.000), percentage of vertebral height restoration (VHR) (P=.000), numbers of fractured vertebrae (P=.013), and numbers of fixed vertebral segments (P=.002).Conclusion: A large amount of HBL was incurred in patients undergoing MIPTSF in thoracolumbar fracture. More importantly, TBL, percentage of VHL, percentage of VHR, the numbers of fractured vertebrae and fixed vertebral segments were independent risk factors for HBL.