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BioMed Research International
Volume 2018, Article ID 6152769, 7 pages
Research Article

Superior Facet Joint Violations during Single Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Preliminary Retrospective Clinical Study

1Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
2Department of Orthopedics, Zhongshan Hospital Affiliated to Fudan University, Qingpu Branch, Shanghai 201700, China
3Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
4Department of Histology and Embryology, Tongji University School of Medicine, Shanghai 200092, China

Correspondence should be addressed to Zhili Zeng; moc.anis@667599lzz and Liming Cheng; nc.ude.ijgnot@gnehcgnimil

Received 2 October 2017; Revised 25 December 2017; Accepted 16 January 2018; Published 5 March 2018

Academic Editor: Panagiotis Korovessis

Copyright © 2018 Long Jia et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Facet joint violation (FV) was reported as variable iatrogenic damage that can be a crucial risk factor leading to the adjacent segment degeneration (ASD). “Blind” screw placement technique in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) contributes to the increasing incidence of FV that can be influenced by several potential factors. Many controversies about these factors and clinical outcomes of different types of FV patients exist, yet they have not been analyzed. Methods. 99 cases undergoing single-segment MIS-TLIF from July 2013 to December 2015 were retrospectively analyzed. Computed tomography (CT) was applied to determine the incidence of FV, and then the correlation between FV and relevant factors, including gender, age, body mass index (BMI), top-screw level, and decompression, was analyzed. A total of 53 cases were followed up after one year, 31 cases in noninjury (A group) and 22 patients in FV injury (B group). Results. The incidence of FV was 39. 39% (39/99) in the patients and 23.23% (46/198) in the screws. Logistic regression analysis showed that screw at L5 in patients with BMI > 30 kg/m2 was vulnerable to FV (). Moreover, postoperative average intervertebral disc height (AIDH) of fusion segment, visual analog scale (VAS), and Oswestry disability index (ODI) scores improved significantly in group A and B when compared with preoperative data (). Adjacent superior average intervertebral disc height (ASAIDH) presented decrease, but adjacent superior intervertebral disc Cobb angle (ASIDCA) appeared to increase in the two groups at the final follow-up compared with postoperative 3 days (). Low back VAS and ODI scores in group A (31 cases) were lower than those in group B (22 cases) in the final follow-up (). Conclusion. MIS-TLIF is an effective treatment for lumbar degenerative disease, but FV occurred at a higher incidence. Facet joints should be protected in MIS-TLIF to avoid FV.