Abstract
Objective: To document the incidence of adjacent superior segment facet joint violation following transpedicular instrumentation in the lumbar spine as it has been postulated that this can lead to long term deterioration There has been no study so far determining this incidence.
Design: Patients undergoing lumbar fusion were prospectively evaluated with a CT scan and plain radiographs six months following surgery. These were blindly and independantly evaluated by a consultant radiologist and a research fellow.
Subjects: 106 patients (212 top level facet screws) between 1996 and 1999 were evaluated. All patients had their screws and instrumentation inserted through a Wiltse muscle splitting approach and a lateral entry point in the pedicle so as to reduce the risk of facetal impingement. 1
Outcome Measures: Kappa co-efficient and chi-squared analysis.
Results: The Kappa co-efficient for the CT scan and plain radiographs were 0.88 and 0.39 respectively. On the CT scan both observers noted facet joint impingement in just over 20% of the screws and just over 30% of the patients. The impingement was independent of the level and diagnosis (p> 0.05) and it occurred with uniform incidence in each of the year.
Conclusion: This study raises the theoretical possibility of long term deterioration in the clinical results following the use of transpedicular instrumentaion.
Abstracts prepared by Mr. A. J. Stirling, FRCS, and Miss A. Weaver. Correspondence should be addressed to Miss A. Weaver at the Research and Teaching Centre, Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP, UK
BritSpine 2002, the second combined meeting of the British Association of Spinal Surgeons, the British Cervical Spine Society, The British Scoliosis Society and the Society for Back Pain Research, took place at the International Convention Centre in Birmingham UK between 27th February and 1st March 2002. The following presentations and posters were given and displayed.
Reference:
1 Fraser RD, Hall DJ. Laminectomy combined with posterolateral stabilisation: A muscle sparing approach to the lumbosacral spine. Eur Spine J1993;1: 249–253 Google Scholar
