Facet joint violation after single-position versus dual-position lateral interbody fusion and percutaneous pedicle screw fixation: A comparison of two techniques

Background: The purpose of this study was to compare the incidence of facet joint violation (FJV) after placement of percutaneous pedicle screws (PPSs) in 2 cohorts of patients who underwent surgery in a single position or dual position following lateral lumbar interbody fusion (LLIF) (extreme lateral interbody fusion [XLIF]). Methods: We reviewed 82 patients who underwent combined XLIF surgery and PPS fixation for the treatment of degenerative lumbar spinal disorders. Patient demographics were compared between 2 groups: those who remained in the lateral decubitus position for PPS fixation (SP group) and those who were turned to the prone position (DP group). Postoperative axial computed tomography scans were evaluated independently for FJV according to the following classification: grade 0, no impingement; grade 1, screw head in contact/suspected to be in contact with the facet joint; and grade 2, screw clearly invaded the facet joint. Results: A total of 349 screws were graded. Using the consensus grades, the incidence of FJV was 13.2% (46/349), but the incidence of FJV did not differ significantly according to the position of the patient during PPS insertion (SP group; 15.4%, DP group; 10.8%, P = 0.204). Conclusions: Although the incidence of FJV after PPS insertion did not differ between the prone and lateral decubitus positions, grade 2 FJV was observed only in the SP group. To avoid FJV, the surgeon should pay close attention to the facet joints when inserting PPSs with the patient in a lateral decubitus position. (C) 2020 Elsevier Ltd. All rights reserved.