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; Gabriele Costantino; Alessandro Villa; Domenico Gerardo Iacopino; Maria Pia Pappalardo; Fabio Barone; Cristina Gallo; Antonino Odierna Contino; Francesco Meli; Rosario Maugeri

doi:10.1055/s-0037-1607196

Journal of Neurological Surgery Part A: Central European Neurosurgery, Table of Contents

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

¹Department of Neurosurgery, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Civico Di Cristina Benfratelli, Palermo, Sicilia, Italy

,

Gabriele Costantino

²Department of Neurosurgery, ARNAS Civico Hospital, Palermo, Italy

,

Alessandro Villa

²Department of Neurosurgery, ARNAS Civico Hospital, Palermo, Italy

,

Domenico Gerardo Iacopino

³Department of Experimental Biomedicine and Clinical Neurosciences, AOU Policlinico Paolo Giaccone, Palermo, Italy

,

Maria Pia Pappalardo

⁴Department of Neuro Radiology, ARNAS Civico Hospital, Palermo, Italy

,

Fabio Barone

⁴Department of Neuro Radiology, ARNAS Civico Hospital, Palermo, Italy

,

Cristina Gallo

⁴Department of Neuro Radiology, ARNAS Civico Hospital, Palermo, Italy

,

Antonino Odierna Contino

¹Department of Neurosurgery, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Civico Di Cristina Benfratelli, Palermo, Sicilia, Italy

,

Francesco Meli

²Department of Neurosurgery, ARNAS Civico Hospital, Palermo, Italy

,

Rosario Maugeri

⁵Department of Neurosurgery, Università degli Studi di Palermo, Palermo, Italy

› Author Affiliations

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

Full Text

References

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