Comparison of superior-level facet joint violations during open and percutaneous pedicle screw placement.
Date
2012-11
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Abstract
Background
Superior-level facet joint violation by pedicle screws may result in increased stress to the level above the instrumentation and may contribute to adjacent segment disease. Previous studies have evaluated facet joint violations in open or percutaneous screw cases, but there are no reports describing a direct institutional comparison.Objective
To compare the incidence of superior-level facet violation for open vs percutaneous pedicle screws and to evaluate patient and surgical factors that affect this outcome.Methods
We reviewed 279 consecutive patients who underwent an index instrumented lumbar fusion from 2007 to 2011 for degenerative spine disease with stenosis with or without spondylolisthesis. We used a computed tomography grading system that represents progressively increasing grades of facet joint violation. Patient and surgical factors were evaluated to determine their impact on facet violation.Results
Our cohort consisted of 126 open and 153 percutaneous cases. Percutaneous procedures had a higher overall violation grade (P = .02) and a greater incidence of high-grade violations (P = .006) compared with open procedures. Bivariate analysis showed significantly greater violations in percutaneous cases for age < 65 years, obesity, pedicle screws at L4, and 1- and 2-level surgeries. Multivariate analysis showed the percutaneous approach and depth of the spine to be independent risk factors for high-grade violations.Conclusion
This study demonstrates greater facet violations for percutaneously placed pedicle screws compared with open screws.Type
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Publication Info
Babu, Ranjith, Jong G Park, Ankit I Mehta, Tony Shan, Peter M Grossi, Christopher R Brown, William J Richardson, Robert E Isaacs, et al. (2012). Comparison of superior-level facet joint violations during open and percutaneous pedicle screw placement. Neurosurgery, 71(5). pp. 962–970. 10.1227/neu.0b013e31826a88c8 Retrieved from https://hdl.handle.net/10161/31396.
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Scholars@Duke
![Grossi](https://scholars.duke.edu/profile-images/thumbnail200/0206422.jpg)
Peter Michael Grossi
I’ve wanted to be a doctor for as long as I can remember. I grew up in a suburb of Washington, DC, came to Duke for medical school in 1998, and have been here ever since. I chose neuroscience as my undergraduate major at Amherst University in MA, and stayed with neurosurgery because I was fascinated with the brain and its functions. I enjoy caring for my patients and seeing someone experience a good outcome that positively changed their life. When I’m not working, I enjoy spending time with my wife, who is also a doctor, and our two young daughters. I play golf when I can, which is not often, and really enjoy cooking. If I hadn’t chosen neurosurgery for my career, I would have gone to culinary school.
![Brown](https://scholars.duke.edu/profile-images/thumbnail200/0235481.jpg)
Christopher Robert Brown
As an orthopaedic specialist and spine surgeon, I am committed to providing the best possible outcome for my patients with the least invasive surgery possible. I treat patients using the latest minimally invasive surgical techniques. Among the conditions I see in my patients are cervical radiculopathy and myelopathy, and traumatic spine injuries. Among the procedures I perform are complex cervical reconstruction, disc replacement surgery, minimally invasive scoliosis surgery, motion preservation spine surgery, and metastatic and tumor surgery.
![Kuchibhatla](https://scholars.duke.edu/profile-images/thumbnail200/0115645.jpg)
Maragatha Kuchibhatla
Statistical research methodology, analysis of repeated measurements, latent growth curve models, latent class growth models, classification and regression trees,
designing clinical trials, designing clinical trials in psychiatry -- both treatment and non-treatment
trials in various comorbid populations.
![Gottfried](https://scholars.duke.edu/profile-images/thumbnail200/0537644.jpg)
Oren N Gottfried
I specialize in the surgical management of all complex cervical, thoracic, lumbar, or sacral spinal diseases by using minimally invasive as well as standard approaches for arthritis or degenerative disease, deformity, tumors, and trauma. I have a special interest in the treatment of thoracolumbar deformities, occipital-cervical problems, and in helping patients with complex spinal issues from previously unsuccessful surgery or recurrent disease.I listen to my patients to understand their symptoms and experiences so I can provide them with the information and education they need to manage their disease. I make sure my patients understand their treatment options, and what will work best for their individual condition. I treat all my patients with care and concern – just as I would treat my family. I am available to address my patients' concerns before and after surgery. I aim to improve surgical outcomes for my patients and care of all spine patients with active research evaluating clinical and radiological results after spine surgery with multiple prospective databases. I am particularly interested in prevention of spinal deformity, infections, complications, and recurrent spinal disease. Also, I study whether patient specific variables including pelvic/sacral anatomy and sagittal spinal balance predict complications from spine surgery.
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