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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
 

  • References

  • 1 Goel A, Shah A, Jadhav M, Nama S. Distraction of facets with intraarticular spacers as treatment for lumbar canal stenosis: report on a preliminary experience with 21 cases. J Neurosurg Spine 2013; 19 (06) 672-677
    CrossrefPubMedGoogle Scholar
  • 2 Caterini R, Mancini F, Bisicchia S, Maglione P, Farsetti P. The correlation between exaggerated fluid in lumbar facet joints and degenerative spondylolisthesis: prospective study of 52 patients. J Orthop Traumatol 2011; 12 (02) 87-91
    CrossrefPubMedGoogle Scholar
  • 3 Landi A, Gregori F, Mancarella C. , et al. Lumbar spinal degenerative “microinstability”: hype or hope? Proposal of a new classification to detect it and to assess surgical treatment. Eur Spine J 2015; 24 (Suppl. 07) 872-878
    PubMedGoogle Scholar
  • 4 King D. Internal fixation for lumbosacral fusion. Am J Surg 1944; 66: 357-361
    CrossrefPubMedGoogle Scholar
  • 5 Boucher HH. A method of spinal fusion. J Bone Joint Surg 1959; 41B: 248-259
    PubMedGoogle Scholar
  • 6 Hartensuer R, Riesenbeck O, Schulze M. , et al. Biomechanical evaluation of the Facet Wedge: a refined technique for facet fixation. Eur Spine J 2014; 23 (11) 2321-2329
    CrossrefPubMedGoogle Scholar
  • 7 Goel A, Goel AA, Satoskar SR, Mehta PH. Double insurance transfacetal screws for lumbar spinal stabilization. J Craniovertebr Junction Spine 2014; 5 (02) 85-87
    CrossrefPubMedGoogle Scholar
  • 8 Graziano F, Maugeri R, Basile L, Meccio F, Iacopino DG. Autologous fibrin sealant (Vivostat(®)) in the neurosurgical practice: Part II: Vertebro-spinal procedures. Surg Neurol Int 2016; 7 (Suppl. 03) S77-S82
    PubMedGoogle Scholar
  • 9 Graziano F, Certo F, Basile L. , et al. Autologous fibrin sealant (Vivostat(®)) in the neurosurgical practice: Part I: Intracranial surgical procedure. Surg Neurol Int 2015; 6: 77
    CrossrefPubMedGoogle Scholar
  • 10 Maugeri R, Basile L, Giugno A, Graziano F, Iacopino DG. Impasse in the management of recurrent basal cell carcinoma of the skull with sagittal sinus erosion. Interdiscip Neurosurg 2015; 2 (03) 160-163
    PubMedGoogle Scholar
  • 11 Maugeri R, Giammalva GR, Graziano F, Iacopino DG. May autologue fibrin glue alone enhance ossification? An unexpected spinal fusion. World Neurosurg 2016; 95: 611-612
    CrossrefPubMedGoogle Scholar
  • 12 Hipp JA, Guyer RD, Zigler JE, Ohnmeiss DD, Wharton ND. Development of a novel radiographic measure of lumbar instability and validation using the facet fluid sign. Int J Spine Surg 2015; 9: 37
    CrossrefPubMedGoogle Scholar
  • 13 White III AA, Panjabi MM. The basic kinematics of the human spine. A review of past and current knowledge. Spine 1978; 3 (01) 12-20
    CrossrefPubMedGoogle Scholar
  • 14 Schinnerer KA, Katz LD, Grauer JN. MR findings of exaggerated fluid in facet joints predicts instability. J Spinal Disord Tech 2008; 21 (07) 468-472
    CrossrefPubMedGoogle Scholar
  • 15 Lattig F, Fekete TF, Kleinstück FS, Porchet F, Jeszenszky D, Mannion AF. Lumbar facet joint effusion on MRI as a sign of unstable degenerative spondylolisthesis: should it influence the treatment decision?. J Spinal Disord Tech 2015; 28 (03) 95-100
    CrossrefPubMedGoogle Scholar
  • 16 Lattig F, Fekete TF, Grob D, Kleinstück FS, Jeszenszky D, Mannion AF. Lumbar facet joint effusion in MRI: a sign of instability in degenerative spondylolisthesis?. Eur Spine J 2012; 21 (02) 276-281
    CrossrefPubMedGoogle Scholar
  • 17 Chaput C, Padon D, Rush J, Lenehan E, Rahm M. The significance of increased fluid signal on magnetic resonance imaging in lumbar facets in relationship to degenerative spondylolisthesis. Spine 2007; 32 (17) 1883-1887
    CrossrefPubMedGoogle Scholar
  • 18 Bendo JA, Ong B. Importance of correlating static and dynamic imaging studies in diagnosing degenerative lumbar spondylolisthesis. Am J Orthop 2001; 30 (03) 247-250
    PubMedGoogle Scholar
  • 19 Lee SE, Jahng TA, Kim HJ. Facet joint changes after application of lumbar nonfusion dynamic stabilization. Neurosurg Focus 2016; 40 (01) E6
    CrossrefPubMedGoogle Scholar
  • 20 Rihn JA, Lee JY, Khan M. , et al. Does lumbar facet fluid detected on magnetic resonance imaging correlate with radiographic instability in patients with degenerative lumbar disease?. Spine 2007; 32 (14) 1555-1560
    CrossrefPubMedGoogle Scholar
  • 21 Cho BY, Murovic JA, Park J. Imaging correlation of the degree of degenerative L4-5 spondylolisthesis with the corresponding amount of facet fluid. J Neurosurg Spine 2009; 11 (05) 614-619
    CrossrefPubMedGoogle Scholar
  • 22 Hasegawa K, Kitahara K, Shimoda H, Hara T. Facet joint opening in lumbar degenerative diseases indicating segmental instability. J Neurosurg Spine 2010; 12 (06) 687-693
    CrossrefPubMedGoogle Scholar
  • 23 Snoddy MC, Sielatycki JA, Sivaganesan A, Engstrom SM, McGirt MJ, Devin CJ. Can facet joint fluid on MRI and dynamic instability be a predictor of improvement in back pain following lumbar fusion for degenerative spondylolisthesis?. Eur Spine J 2016; 25 (08) 2408-2415
    CrossrefPubMedGoogle Scholar
  • 24 Fujiwara A, Tamai K, Yamato M. , et al. The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Eur Spine J 1999; 8 (05) 396-401
    CrossrefPubMedGoogle Scholar
  • 25 Mori K, Nishizawa K, Nakamura A, Imai S. Short-term clinical result of cortical bone trajectory technique for the treatment of degenerative lumbar spondylolisthesis with more than 1-year follow-up. Asian Spine J 2016; 10 (02) 238-244
    CrossrefPubMedGoogle Scholar
  • 26 Snyder LA, Martinez-Del-Campo E, Neal MT. , et al. Lumbar spinal fixation with cortical bone trajectory pedicle screws in 79 patients with degenerative disease: perioperative outcomes and complications. World Neurosurg 2016; 88: 205-213
    CrossrefPubMedGoogle Scholar
  • 27 Glennie RA, Dea N, Kwon BK, Street JT. Early clinical results with cortically based pedicle screw trajectory for fusion of the degenerative lumbar spine. J Clin Neurosci 2015; 22 (06) 972-975
    CrossrefPubMedGoogle Scholar
  • 28 Fabrizi AP, Maina R, Schiabello L. Interspinous spacers in the treatment of degenerative lumbar spinal disease: our experience with DIAM and Aperius devices. Eur Spine J 2011; 20 (Suppl. 01) S20-S26
    CrossrefPubMedGoogle Scholar
  • 29 Surace MF, Fagetti A, Fozzato S, Cherubino P. Lumbar spinal stenosis treatment with Aperius perclid interspinous system. Eur Spine J 2012; 21 (Suppl. 01) S69-S74
    CrossrefPubMedGoogle Scholar
  • 30 Buric J, Pulidori M. Long-term reduction in pain and disability after surgery with the interspinous device for intervertebral assisted motion (DIAM) spinal stabilization system in patients with low back pain: 4-year follow-up from a longitudinal prospective case series. Eur Spine J 2011; 20 (08) 1304-1311
    CrossrefPubMedGoogle Scholar
  • 31 Jutte PC, Castelein RM. Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations. Eur Spine J 2002; 11 (06) 594-598
    CrossrefPubMedGoogle Scholar
  • 32 Gautschi OP, Schatlo B, Schaller K, Tessitore E. Clinically relevant complications related to pedicle screw placement in thoracolumbar surgery and their management: a literature review of 35,630 pedicle screws. Neurosurg Focus 2011; 31 (04) E8
    PubMedGoogle Scholar
  • 33 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
  • 34 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
  • 35 Verhoof OJ, Bron JL, Wapstra FH, van Royen BJ. High failure rate of the interspinous distraction device (X-Stop) for the treatment of lumbar spinal stenosis caused by degenerative spondylolisthesis. Eur Spine J 2008; 17 (02) 188-192
    CrossrefPubMedGoogle Scholar
  • 36 Barbagallo GM, Olindo G, Corbino L, Albanese V. Analysis of complications in patients treated with the X-Stop Interspinous Process Decompression System: proposal for a novel anatomic scoring system for patient selection and review of the literature. Neurosurgery 2009; 65 (01) 111-119 ; discussion 119–120
    CrossrefPubMedGoogle Scholar
  • 37 Moojen WA, Arts MP, Jacobs WC. , et al; Leiden The Hague Spine Intervention Prognostic Study Group (SIPS). IPD without bony decompression versus conventional surgical decompression for lumbar spinal stenosis: 2-year results of a double-blind randomized controlled trial. Eur Spine J 2015; 24 (10) 2295-2305
    CrossrefPubMedGoogle Scholar
  • 38 Strömqvist BH, Berg S, Gerdhem P. , et al. X-stop versus decompressive surgery for lumbar neurogenic intermittent claudication: randomized controlled trial with 2-year follow-up. Spine 2013; 38 (17) 1436-1442
    CrossrefPubMedGoogle Scholar
  • 39 Lønne G, Johnsen LG, Rossvoll I. , et al. Minimally invasive decompression versus x-stop in lumbar spinal stenosis: a randomized controlled multicenter study. Spine 2015; 40 (02) 77-85
    CrossrefPubMedGoogle Scholar
  • 40 Siewe J, Selbeck M, Koy T. , et al. Indications and contraindications: interspinous process decompression devices in lumbar spine surgery. J Neurol Surg A 2015; 76 (01) 1-7
    Article in Thieme ConnectPubMedGoogle Scholar