Relation Between Adjacent Superior Segmental Disease and Facet Joint Violations After Posterolateral Lumbar Fusion

Kyu Yeol Lee; Man Seok Ko; Woo Chul Kim; Sung Gon You; Hyung Min Yoon

doi:10.4184/JKSS.2021.20.1.16

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Lee, Ko, Kim, You, and Yoon: Relation Between Adjacent Superior Segmental Disease and Facet Joint Violations After Posterolateral Lumbar Fusion

Original Research

J Korean Soc Spine Surg 2013;20(1):16-21.

Published online: 18 March 2013

DOI: https://doi.org/10.4184/JKSS.2021.20.1.16

Relation Between Adjacent Superior Segmental Disease and Facet Joint Violations After Posterolateral Lumbar Fusion

Kyu Yeol Lee, M.D., Man Seok Ko, M.D., Woo Chul Kim, M.D., Sung Gon You, M.D., Hyung Min Yoon, M.D.

Department of Orthopedic Surgery, College of Medicine, Dong-A University

Corresponding author: Kyu Yeol Lee, M.D. Department of Orthopedic Surgery, College of Medicine, Dong-A University, 1, Dongdaesin-dong 3-ga, Seo-gu, Busan 602-715, Korea TEL: 82-51-240-2867, FAX: 82-51-243-9764 E-mail: gylee@dau.ac.kr

Received 20 December 20115 June 2012 Accepted 31 October 2012

“This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.”

Abstract

Study Design

To analyze the relationship between the adjacent superior segment disease and facet joint violations after lumbar fusion.

Objectives

We retrospectively analyzed the relationship between the adjacent superior segment disease and facet joint violations after lumbar fusion.

Summary of Literature Review

Among numerous literatures regarding adjacent superior segment disease, there is no analysis concerning the relationship between adjacent superior segment disease and facet joint violations after lumbar fusion.

Materials and Methods

We reviewed 2056 patients who underwent lumbar fusion, between March 2004 and April 2009. Analysis was performed for 79 (3.8%) of the 2056 patients with adjacent superior segment disease and needed a second operation. A facet joint was considered as 3 types of violations with computed tomography scans if any of the following situations were encountered: pedicle screw clearly within the facet joint; pedicle screw head clearly within the facet joint; and pedicle screw and/or screw head within 1mm from or abutting the facet joint, without clear joint involvement.

Results

The incidence of the violations was 45% (36/79) of all patients and 28% (44/158) of all screws. The incidence of L4-5 facet joint violations was 35% (28/79) of patients with adjacent superior segment disease, statistically.

Conclusions

Facet joint violations were observed in patients with the adjacent superior segment disease after posterolateral lumbar fusion. Because L3-4 facet joint violations increased when L4-5 fusion was done, more care should be taken to avoid facet joint violations when the surgeon is considered for insertion of the pedicle screws at L4-5.

Keywords: Adjacent superior segment disease, Lumbar fusion, Facet joint, Violations

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Fig. 1.

Type 1 violations. The white arrow indicates that the pedicle screw is clearly within the facet joint.

Fig. 2.

Type 2 violations. The white arrow indicates that the pedicle screw head is apparently within the facet joint.

Fig. 3.

Type 3 violations. The white arrow indicates that the pedicle screw and/or screw head are within 1 mm from or abutting the facet joint without clear joint involvement.

Table 1.

Distribution of superior facet joint violations by patient clinical characteristics

Characteristics	Total number of patients (%)	Number of violations (%)			p-value
Characteristics	Total number of patients (%)	None	Unilateral	Bilateral	p-value
Overall	79	43 (55)	28 (35)	8 (10)
Gender (female/male)	41 (52) /38 (48)	20 (49)/17 (45)	16 (39)/18 (47)	5 (12)/3 (8)	0.872
Secondary preoperative diagnosis					0.251
Spinal stenosis	45 (56)	25 (56)	15 (33)	5 (11)
Segmental instability	15 (19)	4 (27)	9 (60)	2 (13)
Stenosis + instability	19 (25)	14 (74)	4 (21)	1 (5)
Pedicle level					0.046
L3	21 (26)	15 (71)	4 (19)	2 (10)
L4	50 (64)	22 (44)	24 (48)	4 (8)
L5	8 (10)	6 (75)	0 (0)	2 (25)
Number of fused segments					0.454
1	19 (24)	8 (42)	7 (37)	4 (21)
2	35 (44)	20 (57)	11 (31)	4 (12)
3	25 (32)	15 (60)	10 (40)	0

Table 2.

Superior facet joint violations by pedicle screws

Type of superior facet joint violations	Unilateral	Bilateral
Type I	9(9)	2(4)
Type II	7(7)	2(4)
Type III	12(12)	2(4)
Type I+III	0	2(4)
Total number of patients (screws)	28(28)	8(16)

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