Assefa Temesgen G, Ratliff Alexis C, Sawa Anna G U, Kelly Brian P
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
World Neurosurg. 2024 Nov;191:e586-e593. doi: 10.1016/j.wneu.2024.08.168. Epub 2024 Sep 5.
Although pedicle screw and rod instrumentation remains the gold standard method of posterior rod fixation, it is associated with complications, including pedicle breach and facet joint violation. There is current interest in facet joint stabilization with the potential to create a less invasive, natural arch of fixation that may avoid the complications associated with pedicle screw and rod instrumentation. This study examined the stabilizing potential of a novel facet joint fixation device for single-level (L4-L5) fixation in a human cadaveric model.
Six L3-S1 specimens were tested multidirectionally under pure moment loading (7.5 Nm) in 3 conditions: 1) intact, 2) L4-L5 facet fixation without screws, and 3) L4-L5 facet fixation with screws. L4-L5 intervertebral disc angles were measured radiographically. Range of motion (ROM) and disc angles were compared using repeated-measures analysis of variance, with statistical significance set at P < 0.05.
Compared with the intact condition, L4-L5 bilateral facet fixation without or with screw fixation significantly reduced L4-L5 angular ROM in all directions (P ≤ 0.003). No significant differences were observed in cranial and caudal adjacent-segment ROM (P ≥ 0.08) except for L3-L4 fixation in extension, which exhibited small motion increases (0.12° without screws, 0.1° with screws) versus the intact condition (P ≤ 0.003). No statistically significant differences were observed in disc angle values between the conditions (P = 0.87).
Bilateral lumbar facet fixation with and without supplemental transfacet screw fixation provided significant stability. Cranial and caudal adjacent-level ROM was not influenced by facet fixation except for a slight increase in cranial segment motion during extension. Facet fixation did not alter the lordotic intervertebral disc angle at the instrumented level.
尽管椎弓根螺钉和棒材器械仍然是后路棒材固定的金标准方法，但它会引发包括椎弓根穿孔和小关节侵犯在内的并发症。目前人们对小关节稳定化感兴趣，其有可能创建一种侵入性较小的自然固定弓，从而避免与椎弓根螺钉和棒材器械相关的并发症。本研究在人体尸体模型中检验了一种新型小关节固定装置用于单节段（L4-L5）固定的稳定潜力。
六个L3-S1标本在三种情况下于纯力矩加载（7.5 Nm）下进行多方向测试：1）完整状态，2）L4-L5小关节无螺钉固定，3）L4-L5小关节有螺钉固定。通过影像学测量L4-L5椎间盘角度。使用重复测量方差分析比较运动范围（ROM）和椎间盘角度，设定统计学显著性为P < 0.05。
与完整状态相比，L4-L5双侧小关节无螺钉固定或有螺钉固定在所有方向上均显著降低了L4-L5角向ROM（P≤0.003）。除了L3-L4在伸展时的固定，其与完整状态相比显示出小幅度的运动增加（无螺钉时为0.12°，有螺钉时为0.1°）（P≤0.003）外，在头侧和尾侧相邻节段ROM方面未观察到显著差异（P≥0.08）。各情况之间的椎间盘角度值未观察到统计学显著差异（P = 0.87）。
双侧腰椎小关节固定无论有无补充经小关节螺钉固定均提供了显著的稳定性。除了伸展时头侧节段运动略有增加外，头侧和尾侧相邻节段ROM不受小关节固定的影响。小关节固定未改变器械化节段的前凸椎间盘角度。
