Comparison of cranial facet joint violation rates between open and percutaneous pedicle screw placement using intraoperative 3-D CT (o-arm) computer navigation

Sharon C. Yson, Jonathan N. Sembrano, Peter C. Sanders, Edward Rainier G. Santos, Charles Gerald T. Ledonio, David W. Polly

Research output: Contribution to journalArticlepeer-review

52 Scopus citations

Abstract

STUDY DESIGN.: Retrospective study comparing cranial facet joint violation rates of open and percutaneous pedicle screws inserted using 3-dimensional image-guidance. OBJECTIVE.: To determine the rate of cranial facet joint violation in intraoperative computed tomography (CT) image-guided lumbar pedicle screw instrumentation and compare facet joint violation rates between CT image-guided open and percutaneous techniques. SUMMARY OF BACKGROUND DATA.: Facet joint violation by pedicle screws can potentially result in a higher rate of adjacent segment degeneration. Reported cranial facet joint violation rates range from 7% to 100%. Intraoperative image-guidance, which has enhanced pedicle screw placement accuracy, may aid in avoiding impingement of the cranial facet joints. METHODS.: We reviewed 188 cases of 3-dimensional image-guided lumbar pedicle screw instrumentation from November 2006 to December 2011. The cranial screws of each construct were graded by 3 reviewers according to the Seo classification (0 = no impingement; 1 = screw head in contact/suspected to be in contact with joint; 2 = screw clearly invaded the joint) on intraoperative axial CT images. If there was a difference in evaluation, a consensus was reached to arrive at a single grade. The χ2 test was used to determine significance between the open and percutaneous group (α = 0.05). RESULTS.: A total of 370 screws (245 open, 125 percutaneous) were graded. Overall facet joint violation rate was 18.9% (grade 1 = 16.2%, grade 2 = 2.7%). Open technique (grade 1 = 22.4%, grade 2 = 4.1%) had a significantly higher violation rate than percutaneous technique (grade 1 = 4%, grade 2 = 0%) (P < 0.0001). There is a trend of an increasing likelihood of facet joint violation from L1 to L5. CONCLUSION.: The use of intraoperative CT image-guidance in lumbar pedicle screw placement resulted in a facet joint violation rate at the lower end of the reported range in literature. The percutaneous technique has a significantly lower facet violation rate than the open technique.

Original languageEnglish (US)
Pages (from-to)E251-E258
JournalSpine
Volume38
Issue number4
DOIs
StatePublished - Feb 15 2013

Keywords

  • facet impingement
  • intraoperative imaging
  • navigation
  • pedicle screw insertion

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