Journal List > J Korean Soc Spine Surg > v.20(1) > 1075997

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

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.

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Fig. 1.
Type 1 violations. The white arrow indicates that the pedicle screw is clearly within the facet joint.
jkss-20-16f1.tif
Fig. 2.
Type 2 violations. The white arrow indicates that the pedicle screw head is apparently within the facet joint.
jkss-20-16f2.tif
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.
jkss-20-16f3.tif
Table 1.
Distribution of superior facet joint violations by patient clinical characteristics
Characteristics Total number of patients (%) Number of violations (%) p-value
None Unilateral Bilateral
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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