Outcomes of posterior facet versus pedicle screw fixation of circumferential fusion: a cohort study

• Published in: European spine journal Vol. 23; no. 2; pp. 347 - 355
• Main Authors: Buttermann, Glenn R., Thorson, Tague M., Mullin, William J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2014; Springer Nature B.V
• Subjects: Adult; Bone Screws; Female; Humans; Lumbar Vertebrae - surgery; Male; Medicine; Medicine & Public Health; Minimally Invasive Surgical Procedures; Neurosurgery; Original; Original Article; Pain, Postoperative - etiology; Prospective Studies; Spinal Diseases - surgery; Spinal Fusion - adverse effects; Spinal Fusion - methods; Surgical Orthopedics; Treatment Outcome; Facet screw; Pedicle screw; Lumbar; Fusion; Outcomes; Minimally invasive
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-013-2999-7

Purpose To compare single-level circumferential spinal fusion using pedicle ( n  = 27) versus low-profile minimally invasive facet screw ( n  = 35) posterior instrumentation. Method A prospective two-arm cohort study with 5-year outcomes as follow-up was conducted. Assessment included back and leg pain, pain drawing, Oswestry disability index (ODI), pain medication usage, self-assessment of procedure success, and >1-year postoperative lumbar magnetic resonance imaging. Results Significantly less operative time, estimated blood loss and costs were incurred for the facet group. Clinical improvement was significant for both groups ( p  < 0.01 for all outcomes scales). Outcomes were significantly better for back pain and ODI for the facet relative to the pedicle group at follow-up periods >1 year ( p  < 0.05). Postoperative magnetic resonance imaging found that 20 % had progressive adjacent disc degeneration, and posterior muscle changes tended to be greater for the pedicle screw group. Conclusion One-level circumferential spinal fusion using facet screws proved superior to pedicle screw instrumentation.