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Article

The Relationship between Adjacent Segment Pathology and Facet Joint Violation by Pedicle Screw after Posterior Lumbar Instrumentation Surgery

Department of Orthopedic Surgery, Chonnam National University Hospital, Gwangju 61469, Korea
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Author to whom correspondence should be addressed.
Academic Editors: Alan H Daniels and Victor Valderrabano
J. Clin. Med. 2021, 10(13), 2911; https://doi.org/10.3390/jcm10132911
Received: 10 May 2021 / Revised: 20 June 2021 / Accepted: 28 June 2021 / Published: 29 June 2021
(This article belongs to the Special Issue Spinal Disorders: Current Treatment and Future Opportunities)
Transpedicular screw instrumentation systems have been increasingly utilized during the fusion of lumbar spine procedures. The superior segment facet joint violation of the pedicle screw is thought to have potential for accelerating symptomatic adjacent-segment pathology (ASP). The purpose of this study was to investigate the relationship between the superior segment facet joint violation by transpedicular screws and the development of ASP. Among all patients who underwent operations involving one- or two-level posterior lumbar arthrodesis at the Chonnam National University Hospital from 1992 to 2012, 87 patients were selected for this study. Fifty-six patients were included in the ASP group, and 31 were included in the non-ASP group. We used lumbar three-dimensional computed tomography (CT) to assess the violation of the superior facet joint by a transpedicular screw. The assessment is presented in scores ranging from zero to two, with zero indicating no violation (type I); one point indicating suspected violation (type II); and two points indicating definitely facet joint violation (type III). Facet violation was reported in 31 patients in the ASP group (n = 56), and in 13 patients in the non-ASP group (n = 31). The types of facet joint violation according to our scoring system were as follows: type I, 59 screws (52.7%); type II, 26 screws (23.2%); and type III, 27 screws (24.1%) in the ASP group; and type I, 43 screws (69.4%), type II, 14 screws (22.6 %); and type III, 5 screws (8.0%) in the non-ASP group. The score of facet joint violation in each patient according to our scoring system were as follows: 0 points, 25 patients (44.6%); 1 point, 8 patients (14.3%); 2 points, 4 patients (7.1%); 3 points, 11 patients (19.7%); 4 points, 8 patients (14.3%) in the ASP group; and 0 points, 18 patients (58.1%); 1 point, 4 patients (12.9%); 2 points, 7 patients (22.6%); 3 points, 2 patients (6.4%); 4 points, 0 patients (0%) in the non-ASP group. The mean scores were 1.4 points in the ASP group and 0.8 points in the non-ASP group (p < 0.05). We conclude that the position of the pedicle screw farther away from the facet joint surface can reduce the degeneration of the superior adjacent segment. Therefore, close attention to the screw position during surgery may reduce the rate of superior adjacent-segment pathologies. View Full-Text
Keywords: adjacent segment pathology; facet joint violation; posterior lumbar instrumentation; pedicle screw adjacent segment pathology; facet joint violation; posterior lumbar instrumentation; pedicle screw
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MDPI and ACS Style

Oh, H.-S.; Seo, H.-Y. The Relationship between Adjacent Segment Pathology and Facet Joint Violation by Pedicle Screw after Posterior Lumbar Instrumentation Surgery. J. Clin. Med. 2021, 10, 2911. https://doi.org/10.3390/jcm10132911

AMA Style

Oh H-S, Seo H-Y. The Relationship between Adjacent Segment Pathology and Facet Joint Violation by Pedicle Screw after Posterior Lumbar Instrumentation Surgery. Journal of Clinical Medicine. 2021; 10(13):2911. https://doi.org/10.3390/jcm10132911

Chicago/Turabian Style

Oh, Ho-Seok, and Hyoung-Yeon Seo. 2021. "The Relationship between Adjacent Segment Pathology and Facet Joint Violation by Pedicle Screw after Posterior Lumbar Instrumentation Surgery" Journal of Clinical Medicine 10, no. 13: 2911. https://doi.org/10.3390/jcm10132911

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