Download PDF
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2020; 55(05): 642-648
DOI: 10.1055/s-0040-1709200
Artigo Original
Coluna

Pedicle Screws and Facet Violation - The importance of the Angle between the Facet and the Screw

Article in several languages: português | English
Rodrigo Amaral 
1   Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brasil
,
Luiz Pimenta 
1   Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brasil
2   University of California, UCSD, San Diego, CA, Estados Unidos da América
,
Angelo Guarçoni Netto 
1   Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brasil
,
Gabriel Henrique Pokorny 
1   Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brasil
,
Raquel Fernandes 
1   Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brasil
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Objective To verify whether, regardless of the screw placement technique, there is a safe distance or angle in relation to the facets that can prevent violation of the facet joint when the screws are placed.

Methods Retrospective, single, comparative, non-randomized center. We evaluated by axial computed tomography: the angle of the screw/rod in relation to the midline, the angle of the center of the facets in relation to the midline, the distance between the head of the screw/rod to the midline, and the distance from the center of the facets to the midline; the violation of the facet joint will be evaluated in a gradation of 0 to 2. Also will be measured the difference between the angle os the facets and the angle of the screws (Δ Angle) and, the difference between the facet distance and the screw distance (Δ Distance).

Results A total of 212 patients and 397 facets were analyzed (196 on the left and 201 on the right). Of these, 303 were not violated (grade 0), corresponding to 76,32%, and 94 suffered some type of violation (grade 1 and 2), corresponding to 23,68%. The mean of Δ angle was 9.87° +/− 4.66° (grade 0), and of 3.77° +/− 4.93° in facets (grade 1 and 2) (p < 0.001), and the Δ mean distance in cases in which there was no violation was 0.94 arbitrary units (a.u.) +/− 0.39 a.u., while the Δ distance in G1 and G2 cases was 0.56 a.u. +/− 0.25 a.u. (p < 0.001).

Conclusion The measurements of angle and distance between facet and screw can help in the placement of screws. These parameters can be used as safety measures with the most frequent use of surgical navigation techniques.

Keywords

pedicle screws - spinal fusion - x-ray computed tomography - retrospective studies


Publication History

Received: 18 September 2019

Accepted: 27 January 2020

Article published online:
08 June 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revinter Publicações Ltda
Rio de Janeiro, Brazil

 

  • Referências

  • 1 Waldrop R, Cheng J, Devin C, McGirt M, Fehlings M, Berven S. The Burden of Spinal Disorders in the Elderly. Neurosurgery 2015; 77 (Suppl. 04) S46-S50
    CrossrefPubMedGoogle Scholar
  • 2 Buser Z, Ortega B, D'Oro A. et al. Spine Degenerative Conditions and Their Treatments: National Trends in the United States of America. Global Spine J 2018; 8 (01) 57-67
    CrossrefPubMedGoogle Scholar
  • 3 Narain AS, Hijji FY, Markowitz JS, Kudaravalli KT, Yom KH, Singh K. Minimally invasive techniques for lumbar decompressions and fusions. Curr Rev Musculoskelet Med 2017; 10 (04) 559-566
    CrossrefPubMedGoogle Scholar
  • 4 Tamburrelli FC, Meluzio MC, Burrofato A, Perna A, Proietti L. Minimally invasive surgery procedure in isthmic spondylolisthesis. Eur Spine J 2018; 27 (Suppl. 02) 237-243
    CrossrefPubMedGoogle Scholar
  • 5 Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg 2015; 1 (01) 2-18
    CrossrefPubMedGoogle Scholar
  • 6 Teles AR, Paci M, Gutman G. et al. Anatomical and technical factors associated with superior facet joint violation in lumbar fusion. J Neurosurg Spine 2018; 28 (02) 173-180
    CrossrefPubMedGoogle Scholar
  • 7 Kim H-J, Chun HJ, Kang KT. et al. The biomechanical effect of pedicle screws' insertion angle and position on the superior adjacent segment in 1 segment lumbar fusion. Spine (Phila Pa 1976) 2012; 37 (19) 1637-1644
    CrossrefPubMedGoogle Scholar
  • 8 Matsukawa K, Kato T, Yato Y. et al. Incidence and Risk Factors of Adjacent Cranial Facet Joint Violation Following Pedicle Screw Insertion Using Cortical Bone Trajectory Technique. Spine (Phila Pa 1976) 2016; 41 (14) E851-E856
    CrossrefPubMedGoogle Scholar
  • 9 Magerl FP. Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop Relat Res 1984; (189) 125-141
    PubMedGoogle Scholar
  • 10 Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res 1986; (203) 7-17
    PubMedGoogle Scholar
  • 11 Weinstein JN, Spratt KF, Spengler D, Brick C, Reid S. Spinal pedicle fixation: reliability and validity of roentgenogram-based assessment and surgical factors on successful screw placement. Spine (Phila Pa 1976) 1988; 13 (09) 1012-1018
    CrossrefPubMedGoogle Scholar
  • 12 Zhang D, Gao X, Jiang J, Shen Y, Ding W, Cui H. Safe placement of pedicle screw in lumbar spine with minimum three year follow-up: a case series and technical note. Int Orthop 2018; 42 (03) 567-573
    CrossrefPubMedGoogle Scholar
  • 13 Jones-Quaidoo SM, Djurasovic M, Owens 2nd RK, Carreon LY. Superior articulating facet violation: percutaneous versus open techniques. J Neurosurg Spine 2013; 18 (06) 593-597
    CrossrefPubMedGoogle Scholar
  • 14 Knox JB, Dai III JM, Orchowski JR. Superior segment facet joint violation and cortical violation after minimally invasive pedicle screw placement. Spine J 2011; 11 (03) 213-217
    CrossrefPubMedGoogle Scholar
  • 15 Archavlis E, Amr N, Kantelhardt SR, Giese A. Rates of Upper Facet Joint Violation in Minimally Invasive Percutaneous and Open Instrumentation: A Comparative Cohort Study of Different Insertion Techniques. J Neurol Surg A Cent Eur Neurosurg 2018; 79 (01) 1-8
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Wang L, Wang Y, Yu B, Li Z, Li Y. Comparison of cranial facet joint violation rate between percutaneous and open pedicle screw placement: a systematic review and meta-analysis. Medicine (Baltimore) 2015; 94 (05) e504
    CrossrefPubMedGoogle Scholar
  • 17 Xu Z, Tao Y, Li H, Chen G, Li F, Chen Q. Facet angle and its importance on joint violation in percutaneous pedicle screw fixation in lumbar vertebrae: A retrospective study. Medicine (Baltimore) 2018; 97 (22) e10943
    CrossrefPubMedGoogle Scholar
  • 18 Tannous O, Jazini E, Weir TB. et al. Facet Joint Violation During Percutaneous Pedicle Screw Placement: A Comparison of Two Techniques. Spine (Phila Pa 1976) 2017; 42 (15) 1189-1194
    CrossrefPubMedGoogle Scholar
  • 19 Wang H, Ma L, Yang D. et al. Incidence and risk factors of adjacent segment disease following posterior decompression and instrumented fusion for degenerative lumbar disorders. Medicine (Baltimore) 2017; 96 (05) e6032
    CrossrefPubMedGoogle Scholar
  • 20 Babu R, Park JG, Mehta AI. et al. Comparison of superior-level facet joint violations during open and percutaneous pedicle screw placement. Neurosurgery 2012; 71 (05) 962-970
    CrossrefPubMedGoogle Scholar
  • 21 Gao S, Lv Z, Fang H. Robot-assisted and conventional freehand pedicle screw placement: a systematic review and meta-analysis of randomized controlled trials. Eur Spine J 2018; 27 (04) 921-930
    CrossrefPubMedGoogle Scholar
  • 22 Celik SE, Celik S, Kara A, Ince I, Göksu K. Lumbar facet joint angle and its importance on joint violation in lumbar microdiscectomy. Neurosurgery 2008; 62 (01) 168-172
    CrossrefPubMedGoogle Scholar
  • 23 Jia L, Yu Y, Khan K. et al. Superior Facet Joint Violations during Single Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Preliminary Retrospective Clinical Study [Internet]. Biomed Res Int 2018; 2018: 6152769
    PubMedGoogle Scholar