Superior Facet Joint Violations in Single Level Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion: A Comparative Study

Jwalant Y. Patel; Vishal G. Kundnani; Zahirabbas Imtiyaz Merchant; Sanyam Jain; Neilakuo Kire

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자료유형: 학술저널

저자정보: Jwalant Y. Patel (Bombay Hospital and Medical Research Center) Vishal G. Kundnani (Bombay Hospital and Medical Research Center) Zahirabbas Imtiyaz Merchant (Bombay Hospital and Medical Research Center) Sanyam Jain (Bombay Hospital and Medical Research Center) Neilakuo Kire (Bombay Hospital and Medical Research Center)

저널정보: 대한척추외과학회 Asian Spine Journal Asian Spine Journal Vol.14 No.1

발행연도: 2020.1

수록면: 25 - 32 (8page)

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Study Design: Prospective comparative study. Purpose: To compare the incidence of iatrogenic superior facet joint violation (SFV) in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open TLIF (OPEN-TLIF) at a single lower lumbar fusion level and to evaluate the patient and surgical factors influencing the outcome. Overview of Literature: Iatrogenic SFV is a significant risk factor for adjacent segment disease (ASD). Blind screw placement technique in MIS-TLIF contributes to the increasing incidence of iatrogenic SFV which can be influenced by several other potential factors. There are only limited studies comparing the incidence of iatrogenic SFV in MIS-TLIF and OPEN-TLIF. Methods: In total, 225 cases (450 top screws; MIS-TIFL, 120; OPEN-TILF, 105) undergoing single-level lower lumbar fusion were included in the study. Postoperative computed tomography grading system was used to evaluate iatrogenic SFV. Patient and surgical factors such as age, body mass index, top-screw level, side of the top screw, depth of the spine, and superior facet joint angle (SFA) were analyzed in iatrogenic SFV and non-violation groups to determine their influence on iatrogenic SFV. The clinical outcomes in both groups were assessed preoperatively and postoperatively. Results: The overall incidence of iatrogenic SFV and high-grade violations was higher in MIS-TLIF (41.25%) than in OPEN-TLIF (30.4%). In both groups, bivariate analysis showed a significantly greater incidence of the iatrogenic SFV in patients aged <60 years and those with obesity, top pedicle screws at L4, right-sided top screws, SFA >35°, and depth of the spine >50 mm. Conclusions: This study demonstrated that the incidence of iatrogenic SFV is greater in MIS-TLIF than in OPEN-TLIF at a single lower lumbar level. MIS-TLIF is effective for lumbar degenerative disease; however, the incidence of iatrogenic SFV was higher. Patient and surgical factors must be considered to protect the facet joints in both TLIF methods to avoid ASD.

#Lumbar spine #Surgery #Minimally invasive surgery #Lumbar fusion #Lumbar decompression #Facet joints injuries

참고문헌 (26)

참고문헌 신청

Hackenberg L / 2005 / Transforaminal lumbar interbody fusion : a safe technique with satisfactory three to five year results / Eur Spine J 14:551~558

Rosenberg WS / 2001 / Transforaminal lumbar interbody fusion : technique, complications, and early results / Neurosurgery 48:569~574

Schwender JD / 2005 / Minimally invasive transforaminal lumbar interbody fusion(TLIF) : technical feasibility and initial results / J Spinal Disord Tech 18(Suppl):S1~S6

Rao RD / 2005 / Biomechanical changes at adjacent segments following anterior lumbar interbody fusion using tapered cages / Spine 30:2772~2776

Park P / 2004 / Adjacent segment disease after lumbar or lumbosacral fusion : review of the literature / Spine 29:1938~1944

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