Facet Fixation Combined with Lumbar Interbody Fusion: Comparative Analysis of Clinical Experience and A New Method of Surgical Treatment of Patients with Lumbar Degenerative Diseases

Cover Page


Cite item

Full Text

Abstract

Background: For the treatment of patients with degenerative diseases of the lumbar spine the technique of pedicle fixation is widespread, when after open decompression channel structure locking screws are introduced into the vertebral body through the back vertebra legs. We first used a fundamentally new way of fixing the rear using the facet-boards Cage «Facet Wedge», when posterior fixation is done by closing the facet joints with minimally invasive, percutaneous method. We have not found data on the clinical efficacy of facet fixation in scientific literature.

Aims: To compare the clinical efficacy of facet fixation combined with interbody fusion in the treatment of patients with degenerative lumbar spine disease.

Materials and methods: The study included 145 patients who were divided into 2 groups. The study group with long-term observation included patients (n=100) who underwent a new method for lumbar fixation; the method comprises unilateral or bilateral implantation of titanium Cage «facet Wedge» in the joint space facet joint in combination with the anterior, lateral, and transforaminal interbody fusion. Clinical comparison group (n=45) included retrospectively recruited patients who were performed titanium pedicle screw installation after open decompression and interbody fusion posterior lumbar fixation. Dynamic observation and comprehensive evaluation of the treatment clinical results was carried out for 18 months after surgery.

Results: Cage facet installation technology is quite simple, universal for the stabilization of the rear of the complex after interbody fusion from the front, side, and rear access; and does not require the intraoperative application of expensive high-tech equipment. Comparative analysis of the main group showed significantly better results in terms of the duration of the operation [CG 125 (90; 140) min, the CCG 205 (160; 220) min; p=0.01], the volume of blood loss [CG 80 (70; 120) ml, CCG 350 (300; 550) ml; p=0.008], activation time [CG 2 (1; 2) days, 4 CCG (3; 5) days; p=0.02], length of hospitalization [CG 9 (10; 11) days, the CCG 13 (12; 15) days; p=0.03], the level of pain on a visual analog scale [CG 3 (2; 4) mm, CCG 15 (12; 18) mm; p=0.001], quality of life (by index Oswestry) [CG 8 (6; 8) points, the CCG 23 (20; 28) points, p=0.003], and labor rehabilitation [CG 3 (2; 6) months, CCG 9 (6; 12) months; p=0.0001]. The number of postoperative complications in group 1 was 13%, in the 2nd ― 31,1% (p=0,0012). The new method involves fixing the back with considerably less surgical trauma of paravertebral soft tissue that results in early activation of patients, reduction of stay in hospital period, and better functional recovery of patients.

Conclusions: The application of facet fixation combined with interbody fusion in the treatment of patients with degenerative diseases of the lumbar spine allows achieving the best clinical outcomes and fewer postoperative complications during the short and long-term follow-up if compared with the traditional method of transpedicular stabilization. The combination of low-impact and reliability facet fixation techniques for posterior stabilization of the operated segment creates favorable conditions for the restoration of a functional condition of patients, full social and physical rehabilitation.

About the authors

V. A. Byvaltsev

Irkutsk State Medical University;
Railway Clinical Hospital on the station Irkutsk-Passazhirskiy of Russian Railways Ltd;
Scientific Center of Surgery and Traumatology;
Irkutsk State Medical Academy of Continuing Education

Email: byval75vadim@yandex.ru
ORCID iD: 0000-0003-4349-7101
Irkutsk Россия

A. A. Kalinin

Irkutsk State Medical University;
Railway Clinical Hospital on the station Irkutsk-Passazhirskiy of Russian Railways Ltd;
Scientific Center of Surgery and Traumatology;

Author for correspondence.
Email: andrei_doc_v@mail.ru
ORCID iD: 0000-0003-2707-0511
Irkutsk Россия

A. K. Okoneshnikova

Irkutsk State Medical University

Email: alena-okoneshnikova@mail.ru
ORCID iD: 0000-0003-1556-3095
Irkutsk Россия

T. T. Kerimbaev

Irkutsk State Medical University

Email: kerimbaev_t@mail.ru
ORCID iD: 0000-0002-0862-1747
Irkutsk Россия

E. G. Belykh

Irkutsk State Medical University;
Scientific Center of Surgery and Traumatology

Email: e.belykh@yandex.ru
ORCID iD: 0000-0003-2060-5739
Irkutsk Россия

References

  1. Бывальцев В.А., Калинин А.А., Белых Е.Г. и др. Оптимизация результатов лечения пациентов с сегментарной нестабильно- стью поясничного отдела позвоночника при использовании малоинвазивной методики спондилодеза // Вопросы нейрохи- рургии им. Н.Н. Бурденко. ― 2015. ― T.79. ― №3 ― С. 45–54. [Byvaltsev VA, Kalinin AA, Belykh EG, et al. Optimization of segmental lumbar spine instability treatment using minimally invasive spinal fusion technique. Zh Vopr Neirokhir Im N N Burdenko. 2015;79(3):45–54. (In Russ).]
  2. Коновалов H.A., Шевелев И.Н., Корниенко В.Н., Назарен- ко А.Г. Клинико-диагностическая оценка выраженности дегенеративного поражения пояснично-крестцового отдела позвоночника // Анналы клинической и экспериментальной неврологии. ― 2009. ― №1 ― С. 16–21. [Konovalov NA, Shevelev IN, Kornienko VN, Nazarenko AG. Klinikodiagnosticheskaya otsenka vyrazhennosti degenerativnogo porazheniya poyasnichno-kresttsovogo otdela pozvonochnika. Annaly klinicheskoi i eksperimental’noi nevrologii. 2009;(1):16–21. (In Russ).]
  3. Masferrer R, Gomez CH, Karahalios DG, Sonntag VK. Efficacy of pedicle screw fixation in the treatment of spinal instability and failed ЛИТЕРАТУРА back surgery: a 5-year review. J Neurosurg. 1998;89(3):371–377. doi: 10.3171/jns.1998.89.3.0371.
  4. Park Y, Ha JW. Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach. Spine (Phila Pa 1976). 2007;32(5):537– 543. doi: 10.1097/01.brs.0000256473.49791.f4.
  5. Крутько А.В. Сравнительный анализ результатов заднего меж- телового спондилодеза (PLIF) и трансфораминального межте- лового спондилодеза (TLIF) в сочетании с транспедикулярной фиксацией // Вестник травматологии и ортопедии им. Н.Н. При- орова. ― 2012. ― №1. ― С. 12–21. [Krutko AV. Comparative analysms of posterior interbody fusion and transforaminal interbody fusion in combination with transpedicular fixation. Vestnik travmatologii i ortopedii imeni N.N. Priorova. 2012;(1):12–21. (In Russ).]
  6. Logroscino CA, Proietti L, Pola E, et al. A minimally invasive posterior lumbar interbody fusion for degenerative lumbar spine instabilities. Eur Spine J. 2011;20 Suppl 1:S41–45. doi: 10.1007/ s00586-011-1762-1.
  7. Thalgott JS, Chin AK, Ameriks JA, et al. Minimally invasive 360 degrees instrumented lumbar fusion. Eur Spine J. 2000;9 Suppl 1:S51–56. doi: 10.1007/pl00010022.
  8. Blumenthal S, Gill K. Complications of the Wiltse pedicle screw fixation system. Spine (Phila Pa 1976). 1993;18(13):1867–1871. doi: 10.1097/00007632-199310000-00024.
  9. France JC, Yaszemski MJ, Lauerman WC, et al. A randomized prospective study of posterolateral lumbar fusion. Outcomes with and without pedicle screw instrumentation. Spine (Phila Pa 1976). 1999;24(6):553–560. doi: 10.1097/00007632-199903150- 00010.
  10. Jose-Antonio SS, Baabor-Aqueveque M, Silva-Morales F. Philosophy and concepts of modern spine surgery. Acta Neurochir Suppl. 2011;108:23–31. doi: 10.1007/978-3-211-99370-5_5.
  11. Son S, Lee SG, Park CW, Kim WK. Minimally invasive multilevel percutaneous pedicle screw fixation for lumbar spinal diseases. Korean J Spine. 2012;9(4):352–357. doi: 10.14245/ kjs.2012.9.4.352.
  12. Regev GJ, Lee YP, Taylor WR, et al. Nerve injury to the posterior rami medial branch during the insertion of pedicle screws: comparison of mini-open versus percutaneous pedicle screw insertion techniques. Spine (Phila Pa 1976). 2009;34(11):1239–1242. doi: 10.1097/BRS.0b013e31819e2c5c.
  13. Ringel F, Stoffel M, Stuer C, Meyer B. Minimally invasive transmuscular pedicle screw fixation of the thoracic and lumbar spine. Neurosurgery. 2006;59(4Suppl2):ONS361–366. doi: 10.1227/01. NEU.0000223505.07815.74.
  14. Boucher HH. A method of spinal fusion. J Bone Joint Surg Br. 1959;41–B(2):248–259.
  15. Magerl FP. Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop Relat Res. 1984;(189):125– 141. doi: 10.1097/00003086-198410000-00014.
  16. Fujiwara A, Lim TH, An HS, et al. The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine. Spine (Phila Pa 1976). 2000;25(23):3036–3044. doi: 10.1097/00007632-200012010-00011.
  17. Бывальцев В.А., Сороковиков В.А., Белых Е.Г., Арсентьева Н.И. Использование шкал и анкет в вертебрологии // Журнал невро- логии и психиатрии им. C.C. Корсакова. ― 2011. ― Т.111. ― № 9–2 ― С. 51–56. [Byval’tsev VA, Sorokovikov VA, Belykh EG, Arsent’eva NI. The use of scales and questionnaires in vertebrology. Zh Nevrol Psikhiatr Im S S Korsakova. 2011;111(9–2):51–56. (In Russ).]
  18. Belykh E, Giers MB, Preul MC, et al. Prospective comparison of microsurgical, tubular-based endoscopic, and endoscopically assisted diskectomies: clinical effectiveness and complications in railway workers. World Neurosurg. 2016;90:273–280. doi: 10.1016/j. wneu.2016.02.047.
  19. Schwender JD, Holly LT, Rouben DP, Foley K.T. Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech. 2005;18:S1–6. doi: 10.1097/01.bsd.0000132291.50455.d0.
  20. Jacobs RR, Montesano PX, Jackson RP. Enhancement of lumbar spine fusion by use of translaminar facet joint screws. Spine (Phila Pa 1976). 1989;14(1):12–15. doi: 10.1097/00007632-198901000-00003.
  21. Калинин А.А., Бывальцев В.А. Взаимосвязь спондилометри- ческих параметров с клиническим исходом хирургического лечения дегенеративного спондилолистеза при многоуров- невых поражениях поясничных межпозвонковых дисков // Хирургия позвоночника. ― 2015. ― T.12. ― №4 ― С. 56–62. [Kalinin AA, Byvaltsev VA. Relationship between vertebral metric parameters and outcome of surgical treatment of degenerative spondylolisthesis with multilevel lumbar intervertebral disc lesions. Spine surgery. 2015;12(4):56–62. (In Russ).]
  22. Weber BR, Grob D, Dvorak J, Muntener M. Posterior surgical approach to the lumbar spine and its effect on the multifidus muscle. Spine (Phila Pa 1976). 1997;22(15):1765–1772. doi: 10.1097/00007632-199708010-00017.
  23. Reich SM, Kuflik P, Neuwirth M. Translaminar facet screw fixation in lumbar spine fusion. Spine (Phila Pa 1976). 1993;18(4):444–449. doi: 10.1097/00007632-199318040-00007.
  24. Moore KR, Pinto MR, Butler LM. Degenerative disc disease treated with combined anterior and posterior arthrodesis and posterior instrumentation. Spine (Phila Pa 1976). 2002;27(15):1680–1686. doi: 10.1097/00007632-200208010-00018.
  25. Parker SL, Adogwa O, Witham TF, et al. Postoperative infection after minimally invasive versus open transforaminal lumbar interbody fusion (TLIF): literature review and post analysis. Minim Invasive Neurosurg. 2011;54(1):33–37. doi: 10.1055/s-0030-1269904.
  26. Mohi Eldin MM, Hassan AS. Percutaneous transpedicular fixation: technical tips and pitfalls of sextant and pathfinder systems. Asian Spine J. 2016;10(1):111–122. doi: 10.4184/asj.2016.10.1.111.
  27. Lieberman JA, Lyon R, Feiner J, et al. The efficacy of motor evoked potentials in fixed sagittal imbalance deformity correction surgery. Spine (Phila Pa 1976). 2008;33(13):E414–424. doi: 10.1097/ BRS.0b013e318175c292.
  28. Tian W, Han X, Liu B, et al. A robot-assisted surgical system using a force-image control method for pedicle screw insertion. PLoS One. 2014;9(1):e86346. doi: 10.1371/journal.pone.0086346.
  29. Van de Kelft E, Costa F, Van der Planken D, Schils F. A prospective multicenter registry on the accuracy of pedicle screw placement in the thoracic, lumbar, and sacral levels with the use of the O-arm imaging system and StealthStation Navigation. Spine (Phila Pa 1976). 2012;37(25):E1580–1587. doi: 10.1097/ BRS.0b013e318271b1fa.
  30. Jutte PC, Castelein RM. Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations. Eur Spine J. 2002;11(6):594–598. doi: 10.1007/s00586-002- 0469-8.
  31. Al-Khouja L, Shweikeh F, Pashman R, et al. Economics of image guidance and navigation in spine surgery. Surg Neurol Int. 2015;6(Suppl 10):S323–326. doi: 10.4103/2152-7806.159381.
  32. Tuli SK, Eichler ME, Woodard EJ. Comparison of perioperative morbidity in translaminar facet versus pedicle screw fixation. Orthopedics. 2005;28(8):773–778.
  33. Shao RX, Luo P, Lin Y, et al. [Treatment of low lumbar degenerative disease with unilateral pedicle screw combined with contralateral percutaneous transfacet screws fixation. (In Chinese).] Zhongguo Gu Shang. 2015;28(4):318–322.
  34. Hartensuer R, Riesenbeck O, Schulze M, et al. Biomechanical evaluation of the Facet Wedge: a refined technique for facet fixation. Eur Spine J. 2014;23(11):2321–2329. doi: 10.1007/s00586-014-3533-2.
  35. Beaubien BP, Mehbod AA, Kallemeier PM, et al. Posterior augmentation of an anterior lumbar interbody fusion: minimally invasive fixation versus pedicle screws in vitro. Spine (Phila Pa 1976). 2004;29(19):E406–412. doi: 10.1097/01.brs.0000141187.53366.9b.
  36. Jang JS, Lee SH, Lim SR. Guide device for percutaneous placement of translaminar facet screws after anterior lumbar interbody fusion. Technical note. J Neurosurg Spine. 2003;98(1):100–103. doi: 10.3171/spi.2003.98.1.0100.
  37. Shim CS, Lee SH, Jung B, et al. Fluoroscopically assisted percutaneous translaminar facet screw fixation following anterior lumbar interbody fusion: technical report. Spine (Phila Pa 1976). 2005;30(7):838–843. doi: 10.1097/01.brs.0000157473.17313.6f.
  38. Rhee JW, Petteys RJ, Anaizi AN, et al. Prospective evaluation of 1-year outcomes in single-level percutaneous lumbar transfacet screw fixation in the lateral decubitus position following lateral transpsoas interbody fusion. Eur Spine J. 2015;24(11):2546–2554. doi: 10.1007/s00586-015-3934-x.
  39. Voyadzis JM, Anaizi AN. Minimally invasive lumbar transfacet screw fixation in the lateral decubitus position after extreme lateral interbody fusion: a technique and feasibility study. J Spinal Disord Tech. 2013;26(2):98–106. doi: 10.1097/BSD.0b013e318241f6c3.
  40. Xu J, Mao K, Wang Y, et al. [A feasibility research of minimally invasive transforaminal lumbar interbody fusion using unilateral incision and hybrid internal fixation for dural-level lumbar degenerative disease . (In Chinese).] Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013;27(8):955–959.
  41. Jiang X, Feng Z, Liu F, et al. Transforaminal lumbar interbody fusion using unilateral pedicle screw fixation plus contralateral translaminar facet screw fixation in lumbar degenerative diseases. Indian J Orthop. 2014;48(4):374–379. doi: 10.4103/0019- 5413.136240.
  42. Mao KY, Wang Y, Xiao SH, et al. [A feasibility research of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using hybrid internal fixation for recurrent lumbar disc herniation. (In Chinese).] Zhonghua Wai Ke Za Zhi. 2013;51(8):723–727.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2016 "Paediatrician" Publishers LLC



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies