Georgiopoulos Miltiadis, Elkaim Lior M, Alrashidi Qais S, Lasry Oliver, Golan Jeff D
Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.
Spine Surgery, Trauma & Orthopaedics, Swansea Bay University Health Board, Swansea, UK.
Brain Spine. 2025 May 5;5:104274. doi: 10.1016/j.bas.2025.104274. eCollection 2025.
Violation of the non-fused proximal facet joints (PFJ) above instrumentation might be associated with accelerated arthritis and adjacent-segment disease. Standard fluoroscopic views do not allow for an exclusion of PFJ violation and have been associated with high rates of this complication.
We adopted the use of the pedicle axis view (PAV) and investigated our results and potential correlations.
We performed a retrospective cohort study of cases of percutaneous pedicle screw insertion in the lumbar spine, using the PAV. Various factors were investigated on postoperative CT scans, e.g. presence of PFJ violation, PFJ angles and analysis of breaches.
Overall, 311 screws were inserted using the PAV. The percentage of screws that resulted in PFJ violation was 3.7 % (n = 6). Higher PFJ angles played a role with an odds ratio of 1.21 (95 % CI: 1.03-1.43). The majority of the screws (68.1 %) did not cause cortical breaches. Regarding the rates of breaches, 14.9 % were minor cortical breaches and 11.6 % were moderate. 1.9 % of the screws caused severe breaches, but none of those were located medially or inferiorly. None of the observed breaches led to new symptoms or revision.
The adoption of the fluoroscopic PAV for percutaneous lumbar pedicle screws led to low rates of proximal facet joint violation and severe breaches. Moreover, PFJ violation was more prevalent with higher PFJ angles and surgeons should remain vigilant in such cases. None of the observed breaches were clinically relevant.
器械上方未融合的近端小关节（PFJ）损伤可能与关节炎加速和相邻节段疾病有关。标准的透视视图无法排除PFJ损伤，且该并发症发生率较高。
我们采用椎弓根轴位视图（PAV）并研究了结果及潜在相关性。
我们对使用PAV进行腰椎经皮椎弓根螺钉置入的病例进行了回顾性队列研究。在术后CT扫描上研究了各种因素，例如PFJ损伤的存在、PFJ角度和骨皮质破损分析。
总体而言，使用PAV共置入311枚螺钉。导致PFJ损伤的螺钉百分比为3.7%（n = 6）。较高的PFJ角度起了作用，优势比为1.21（95%CI：1.0-1.4）。大多数螺钉（68.1%）未导致骨皮质破损。关于破损率，14.9%为轻度骨皮质破损，11.6%为中度。1.9%的螺钉导致严重破损，但均未位于内侧或下方。观察到的破损均未导致新症状或翻修。
在经皮腰椎椎弓根螺钉置入中采用透视PAV导致近端小关节损伤和严重破损的发生率较低。此外，PFJ角度越高，PFJ损伤越普遍，在这种情况下外科医生应保持警惕。观察到的破损均与临床无关。
