Guide device for percutaneous placement of translaminar facet screws after anterior lumbar interbody fusion. Technical note

Because the degree of immediate stabilization provided by cage-assisted anterior lumbar interbody fusion (ALIF) has been shown by several studies to be inadequate, supplementary posterior fixation, such as that created by translaminar or transpedicle screw fixation, is necessary. In this study, the authors studied the ALIF-augmentation procedure in which a special guide device is used to place percutaneously translaminar facet screws in 18 patients with degenerative lumbar disease. The minimum follow-up period was 1 month (mean 6 months, range 1-13 months). Degenerative spondylolisthesis with foraminal stenosis was diagnosed in nine patients, associated degenerative disc disease alone or combined with foraminal stenosis in eight, and recurrent disc herniation in one. Following screw placement, computerized tomography scanning was conducted to evaluate the accuracy of the facet screw positioning. All screws were properly placed. No screw penetrated the spinal canal or injured the neural structures. Excellent or good clinical outcomes were demonstrated in all patients at the last follow up. The use of this guide device for post-ALIF percutaneous translaminar facet screw fixation represents a safe, accurate, and minimally invasive modality with which to achieve immediate solid fixation in the lumbar spine.