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Analysis of risk factors for adjacent superior vertebral pedicle-induced facet joint violation during the minimally invasive surgery transforaminal lumbar interbody fusion: a retrospective study.

Zeng ZL, Jia L, Xu W, Yu Y, Hu X, Jia YW, Wang JJ, Cheng LM - Eur. J. Med. Res. (2015)

Bottom Line: No correlation was found between gender, screw implant position, SLRT results, clinical diseases and renal dysfunction and facet joint violations.Logistic regression analysis revealed that age <60 years (OR: 2.902; 95 % CI 1.227-6.864; P = 0.015) and BMI ≥30 kg/m(2) (OR: 2.825; 95 % CI 1.191-6.700; P = 0.018 < 0.05) were significantly associated with facet joint violation.These results found a high incidence of adjacent superior vertebral facet joint violation in the MIS-TLIF.

View Article: PubMed Central - PubMed

Affiliation: Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, China. zzl995766@sina.com.

ABSTRACT

Background: The purpose was to explore possible risk factors of facet joint violation induced by adjacent superior vertebral pedicle screw during the minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF).

Methods: A total of 69 patients with lumbar degenerative disease, who underwent MIS-TLIF were retrospectively reviewed. Postoperative computed tomography images were used to assess the facet joint violation. The correlation of facet joint violations with gender, age, body mass index (BMI), the adjacent superior vertebral level, fusion segment numbers, position of screw insertion, straight leg-raising test (SLRT) results, clinical diseases and renal dysfunction were analyzed by Chi-square tests and binary logistic regression analysis.

Results: The incidence of adjacent superior facet joint violations was 25.4 %. Chi-square test showed the patients with age <60 and high BMI (≥30 kg/m(2)) were more prone to have facet joint violations (P = 0.007; P = 0.006). The single segment fusion presented more facet joint violations than the double segments fusion (P = 0.048). The vertebral pedicle screw implant location at L5 showed more facet joint violations compared with that at L3 and L4 (P = 0.035). No correlation was found between gender, screw implant position, SLRT results, clinical diseases and renal dysfunction and facet joint violations. Logistic regression analysis revealed that age <60 years (OR: 2.902; 95 % CI 1.227-6.864; P = 0.015) and BMI ≥30 kg/m(2) (OR: 2.825; 95 % CI 1.191-6.700; P = 0.018 < 0.05) were significantly associated with facet joint violation.

Conclusion: These results found a high incidence of adjacent superior vertebral facet joint violation in the MIS-TLIF. Age <60 and BMI ≥30 kg/m(2) might be risk factors of facet joint violation. Evidence level: Level 4.

No MeSH data available.


Related in: MedlinePlus

The instrument used in the procedure of MIS-TLIF
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Related In: Results  -  Collection

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Fig2: The instrument used in the procedure of MIS-TLIF

Mentions: Patients were kept in prone position following general anesthesia and their abdomen was suspended and pressure parts were with pad. C arm fluoroscopy was used to determine available surgical space. A 2- to 3-cm incision was made approximately 2.5 cm lateral to the midline to cut skin and muscular fasciae. After inserting the dilators step by step, Pipeline working channel (Johnson & Johnson Company, NY, USA, Fig. 1) was placed into and fixed by dilators, or directly using Spotlight working channel (Johnson & Johnson Company, NY, USA, Fig. 2). Then, the local soft tissue was removed to expose vertebral plate edges and facet joint. The decompression was performed to expose dural sac, the central canal, lateral crypt and nerve root canal after removing part of vertebral plate, ligamentum flavum and facet joints. After thoroughly removing intervertebral disc and cartilage endplate, local autologous bone was implanted into intervertebral space, and then single suitable height of intervertebral fusion was placed. For bilateral decompression or more, the same method was performed to deal with the contralateral and other spaces. Under the guidance of C arm fluoroscopy, placement of percutaneous pedicle screws was performed using Viper2 system (Johnson & Johnson Company, NY, USA, Fig. 1) and percutaneous rod was also placed using the instruments and pre-locked. Drainage tube was removed 24–36 h postoperatively. At 3 days postoperatively, the patients were examined with lumbar X-ray and CT to confirm the position of lumbar fusion instruments and internal fixation, and to evaluate the facet joint violation. Moreover, the patients were encouraged to have activities out of bed under waist protection. Waist torsion and bending activities were prohibited within 3 months under waist protection.Fig. 2


Analysis of risk factors for adjacent superior vertebral pedicle-induced facet joint violation during the minimally invasive surgery transforaminal lumbar interbody fusion: a retrospective study.

Zeng ZL, Jia L, Xu W, Yu Y, Hu X, Jia YW, Wang JJ, Cheng LM - Eur. J. Med. Res. (2015)

The instrument used in the procedure of MIS-TLIF
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4581410&req=5

Fig2: The instrument used in the procedure of MIS-TLIF
Mentions: Patients were kept in prone position following general anesthesia and their abdomen was suspended and pressure parts were with pad. C arm fluoroscopy was used to determine available surgical space. A 2- to 3-cm incision was made approximately 2.5 cm lateral to the midline to cut skin and muscular fasciae. After inserting the dilators step by step, Pipeline working channel (Johnson & Johnson Company, NY, USA, Fig. 1) was placed into and fixed by dilators, or directly using Spotlight working channel (Johnson & Johnson Company, NY, USA, Fig. 2). Then, the local soft tissue was removed to expose vertebral plate edges and facet joint. The decompression was performed to expose dural sac, the central canal, lateral crypt and nerve root canal after removing part of vertebral plate, ligamentum flavum and facet joints. After thoroughly removing intervertebral disc and cartilage endplate, local autologous bone was implanted into intervertebral space, and then single suitable height of intervertebral fusion was placed. For bilateral decompression or more, the same method was performed to deal with the contralateral and other spaces. Under the guidance of C arm fluoroscopy, placement of percutaneous pedicle screws was performed using Viper2 system (Johnson & Johnson Company, NY, USA, Fig. 1) and percutaneous rod was also placed using the instruments and pre-locked. Drainage tube was removed 24–36 h postoperatively. At 3 days postoperatively, the patients were examined with lumbar X-ray and CT to confirm the position of lumbar fusion instruments and internal fixation, and to evaluate the facet joint violation. Moreover, the patients were encouraged to have activities out of bed under waist protection. Waist torsion and bending activities were prohibited within 3 months under waist protection.Fig. 2

Bottom Line: No correlation was found between gender, screw implant position, SLRT results, clinical diseases and renal dysfunction and facet joint violations.Logistic regression analysis revealed that age <60 years (OR: 2.902; 95 % CI 1.227-6.864; P = 0.015) and BMI ≥30 kg/m(2) (OR: 2.825; 95 % CI 1.191-6.700; P = 0.018 < 0.05) were significantly associated with facet joint violation.These results found a high incidence of adjacent superior vertebral facet joint violation in the MIS-TLIF.

View Article: PubMed Central - PubMed

Affiliation: Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, China. zzl995766@sina.com.

ABSTRACT

Background: The purpose was to explore possible risk factors of facet joint violation induced by adjacent superior vertebral pedicle screw during the minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF).

Methods: A total of 69 patients with lumbar degenerative disease, who underwent MIS-TLIF were retrospectively reviewed. Postoperative computed tomography images were used to assess the facet joint violation. The correlation of facet joint violations with gender, age, body mass index (BMI), the adjacent superior vertebral level, fusion segment numbers, position of screw insertion, straight leg-raising test (SLRT) results, clinical diseases and renal dysfunction were analyzed by Chi-square tests and binary logistic regression analysis.

Results: The incidence of adjacent superior facet joint violations was 25.4 %. Chi-square test showed the patients with age <60 and high BMI (≥30 kg/m(2)) were more prone to have facet joint violations (P = 0.007; P = 0.006). The single segment fusion presented more facet joint violations than the double segments fusion (P = 0.048). The vertebral pedicle screw implant location at L5 showed more facet joint violations compared with that at L3 and L4 (P = 0.035). No correlation was found between gender, screw implant position, SLRT results, clinical diseases and renal dysfunction and facet joint violations. Logistic regression analysis revealed that age <60 years (OR: 2.902; 95 % CI 1.227-6.864; P = 0.015) and BMI ≥30 kg/m(2) (OR: 2.825; 95 % CI 1.191-6.700; P = 0.018 < 0.05) were significantly associated with facet joint violation.

Conclusion: These results found a high incidence of adjacent superior vertebral facet joint violation in the MIS-TLIF. Age <60 and BMI ≥30 kg/m(2) might be risk factors of facet joint violation. Evidence level: Level 4.

No MeSH data available.


Related in: MedlinePlus