Superior articulating facet violation: percutaneous versus open techniques.

Area of Science:

• Spine surgery
• Orthopedic surgery
• Neurosurgery

Background:

• Percutaneous techniques for pedicle screw placement are increasingly used.
• The incidence of superior facet joint violation with these techniques is a growing concern.
• Comparison between percutaneous and open midline approaches for facet violation is lacking.

Purpose of the Study:

• To compare the rate of superior facet joint violation between percutaneously placed pedicle screws and open midline approach placement.
• To investigate the potential link between facet violation and adjacent-segment disease.

Main Methods:

• Retrospective review of CT scans from patients undergoing single-level fusion (L1-S1).
• Comparison between a percutaneous group and a matched open fusion cohort.
• Facet violation assessed by three fellowship-trained spine surgeons.

Main Results:

• Higher incidence of facet joint violation in the percutaneous group (13.6%) versus the open group (6%).
• This difference remained significant even when considering only proximal screws (12% vs 5%).
• Patients in the percutaneous group were younger (mean 42.5 years) than the open group (mean 57.8 years).

Conclusions:

• Percutaneous pedicle screw insertion is associated with a significantly higher rate of facet joint violation.
• Further research is required to determine if this increased violation leads to symptomatic adjacent-level disease.