Comparison of superior-level facet joint violations during open and percutaneous pedicle screw placement.

Journal Article (Journal Article)

BACKGROUND: Superior-level facet joint violation by pedicle screws may result in increased stress to the level above the instrumentation and may contribute to adjacent segment disease. Previous studies have evaluated facet joint violations in open or percutaneous screw cases, but there are no reports describing a direct institutional comparison. OBJECTIVE: To compare the incidence of superior-level facet violation for open vs percutaneous pedicle screws and to evaluate patient and surgical factors that affect this outcome. METHODS: We reviewed 279 consecutive patients who underwent an index instrumented lumbar fusion from 2007 to 2011 for degenerative spine disease with stenosis with or without spondylolisthesis. We used a computed tomography grading system that represents progressively increasing grades of facet joint violation. Patient and surgical factors were evaluated to determine their impact on facet violation. RESULTS: Our cohort consisted of 126 open and 153 percutaneous cases. Percutaneous procedures had a higher overall violation grade (P = .02) and a greater incidence of high-grade violations (P = .006) compared with open procedures. Bivariate analysis showed significantly greater violations in percutaneous cases for age < 65 years, obesity, pedicle screws at L4, and 1- and 2-level surgeries. Multivariate analysis showed the percutaneous approach and depth of the spine to be independent risk factors for high-grade violations. CONCLUSION: This study demonstrates greater facet violations for percutaneously placed pedicle screws compared with open screws.

Full Text

Duke Authors

Cited Authors

  • Babu, R; Park, JG; Mehta, AI; Shan, T; Grossi, PM; Brown, CR; Richardson, WJ; Isaacs, RE; Bagley, CA; Kuchibhatla, M; Gottfried, ON

Published Date

  • November 2012

Published In

Volume / Issue

  • 71 / 5

Start / End Page

  • 962 - 970

PubMed ID

  • 22843132

Pubmed Central ID

  • PMC3477296

Electronic International Standard Serial Number (EISSN)

  • 1524-4040

Digital Object Identifier (DOI)

  • 10.1227/NEU.0b013e31826a88c8


  • eng

Conference Location

  • United States