Michele Bochicchio1, Rocco Aicale2, Rocco Romeo3, Pier Vittorio Nardi4, Nicola Maffulli5. 1. Department of Orthopaedic and Trauma Surgery, Casa di Cura di Bernardini, 74121 Taranto, Italy. Electronic address: bochicchio.michele@gmail.com. 2. Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy; Clinica Ortopedica, San Giovanni di Dio e Ruggi D'Aragona Hospital, 84131 Salerno, Italy. Electronic address: aicale17@gmail.com. 3. Department of Orthopaedic and Trauma Surgery, Ospedale San Carlo, Via Potito Petrone, 85100 Potenza, PZ, Italy. Electronic address: roccoromeo57@virgilio.it. 4. Ospedale Cristo Re, U.O.C. Neurochirurgia, Via delle Calasanziane, 25, 00167, Rome, Italy. Electronic address: info@professornardi.it. 5. Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy; Clinica Ortopedica, San Giovanni di Dio e Ruggi D'Aragona Hospital, 84131 Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England; School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England. Electronic address: n.maffulli@qmul.ac.uk.
Abstract
BACKGROUND AND PURPOSE: Lumbar stenosis and instability frequently coexist. Spinal canal decompression is often combined with fixation of the relevant vertebral segment and can be performed using different techniques and devices, including pedicle screws and interspinous devices and facet screws. The present study evaluates the clinical outcome of laminectomy and single-level fusion using a minimally invasive technique for rigid posterior spinal column fixation with two cross-linked lag screws. METHODS: The records of patients operated from 2012 to 2016 were retrieved from the computerised medical record database system. Data on age, sex, surgical level, type of deficit and disease were collected. The Oswestry Disability Index (ODI) and Short Form-36 (SF-36) questionnaires were administered pre-operatively and at 1, 6, 12 and 24 months after surgery. MAIN FINDINGS: A total of 46 consecutive patients were operated between January 2012 to October 2016. One intraoperative complication was reported, and 4 patients experienced radiographic pseudarthrosis postoperatively. Five patients underwent additional surgery. The lumbar and lower limb VAS score, ODI and SF-36 scores showed statistically significant improvement for each score at the first and last follow-up (p < 0.01). CONCLUSION: Percutaneous lumbar transfacet screw placement with the Facet-Link ® system is feasible and safe but with a relatively high rate of poor articular fusion. This technique can reduce the morbidity of single-level lumbar spinal stenosis and mild instability and improve patient outcome scores. Comparative studies, including randomised controlled trials, are needed to confirm these findings.
BACKGROUND AND PURPOSE: Lumbar stenosis and instability frequently coexist. Spinal canal decompression is often combined with fixation of the relevant vertebral segment and can be performed using different techniques and devices, including pedicle screws and interspinous devices and facet screws. The present study evaluates the clinical outcome of laminectomy and single-level fusion using a minimally invasive technique for rigid posterior spinal column fixation with two cross-linked lag screws. METHODS: The records of patients operated from 2012 to 2016 were retrieved from the computerised medical record database system. Data on age, sex, surgical level, type of deficit and disease were collected. The Oswestry Disability Index (ODI) and Short Form-36 (SF-36) questionnaires were administered pre-operatively and at 1, 6, 12 and 24 months after surgery. MAIN FINDINGS: A total of 46 consecutive patients were operated between January 2012 to October 2016. One intraoperative complication was reported, and 4 patients experienced radiographic pseudarthrosis postoperatively. Five patients underwent additional surgery. The lumbar and lower limb VAS score, ODI and SF-36 scores showed statistically significant improvement for each score at the first and last follow-up (p < 0.01). CONCLUSION: Percutaneous lumbar transfacet screw placement with the Facet-Link ® system is feasible and safe but with a relatively high rate of poor articular fusion. This technique can reduce the morbidity of single-level lumbar spinal stenosis and mild instability and improve patient outcome scores. Comparative studies, including randomised controlled trials, are needed to confirm these findings.