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J Neurol Surg A Cent Eur Neurosurg 2018; 79(04): 296-301
DOI: 10.1055/s-0037-1607196
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Preliminary Experience with a Novel System of Facet Fixation to Treat Patients with Lumbar Degenerative Disease. A New Perspective in Minimally Invasive Spine Surgery?

Natale Francaviglia
1   Department of Neurosurgery, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Civico Di Cristina Benfratelli, Palermo, Sicilia, Italy
,
Gabriele Costantino
2   Department of Neurosurgery, ARNAS Civico Hospital, Palermo, Italy
,
Alessandro Villa
2   Department of Neurosurgery, ARNAS Civico Hospital, Palermo, Italy
,
Domenico Gerardo Iacopino
3   Department of Experimental Biomedicine and Clinical Neurosciences, AOU Policlinico Paolo Giaccone, Palermo, Italy
,
Maria Pia Pappalardo
4   Department of Neuro Radiology, ARNAS Civico Hospital, Palermo, Italy
,
Fabio Barone
4   Department of Neuro Radiology, ARNAS Civico Hospital, Palermo, Italy
,
Cristina Gallo
4   Department of Neuro Radiology, ARNAS Civico Hospital, Palermo, Italy
,
Antonino Odierna Contino
1   Department of Neurosurgery, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Civico Di Cristina Benfratelli, Palermo, Sicilia, Italy
,
Francesco Meli
2   Department of Neurosurgery, ARNAS Civico Hospital, Palermo, Italy
,
Rosario Maugeri
5   Department of Neurosurgery, Università degli Studi di Palermo, Palermo, Italy
› Author Affiliations
Further Information

Publication History

21 February 2017

17 July 2017

Publication Date:
17 October 2017 (online)

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Abstract

Purpose We report our experience with a novel surgical device for the treatment of lumbar degenerative microinstability. Facet Wedge (DePuy Synthes, Raynham, Massachusetts, United States) is a novel technique of intra-articular lumbar facet fixation that provides a minimally invasive alternative to standard posterior fixation.

Materials and Methods From November 2014 to July 2015, 38 patients underwent single-level Facet Wedge implantation. The main surgical indications included herniated disk (18 patients), spinal canal and foraminal stenosis (14 patients), and Meyerding grade I degenerative spondylolisthesis (6 patients). All the patients showed radiologic signs of microinstability: hyperintensity in both facet joints (facet fluid signal) in T2-weighted magnetic resonance imaging and a black disk as a sign of degenerative disease. No slippage was evident at dynamic radiograph. After a period of conservative treatment (minimum of 6 months), surgery was performed. All patients' follow-up lasted over at least 12 months.

Results The low back visual analog scale score decreased significantly after surgery (from an average of 8.2 to 3.1 at final follow-up). Postoperatively, the Oswestry Disability Index showed a significant reduction (14.7 on average). No slippage or signs of adjacent segment degeneration was detected in neuroimaging follow-up.

Conclusion Facet Wedge allows facet fixation in lumbar degenerative microinstability. To the best of our knowledge, this is the first clinical series reported in the literature on this novel device.

Keywords

degenerative lumbar disease - facet fluid signal - facet wedge - facet fusion - microinstability
 

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