Koc Natalia Anna, Oleksy Piotr, Szyduczyński Maciej, Krakowiak Michał, Szmuda Tomasz, Zieliński Piotr, Miękisiak Grzegorz
Medical University of Gdańsk, Gdańsk, Poland.
Medical University of Silesia, Katowice, Poland.
Eur Spine J. 2025 Jun 9. doi: 10.1007/s00586-025-09015-4.
Facet joint violation (FJV) is an underreported consequence of screw placement in spine surgery, significantly impacting load-bearing capability of the level. Rates of FJV range from 6.3 to 100% due to variability in surgical techniques, navigation methods, and FJV definitions. This study identifies FJV predictors during lumbar fusion in minimally invasive spine surgery (MISS) and open procedures.
Literature review was performed according to PRISMA guidelines. PubMed, Web of Science and Scopus were searched using keywords "MIS", "minimally invasive", "percutaneous", "endoscopic", "open", "conventional", "traditional", "lumbar fusion", "spine fusion", "FJV", "facet joint violation". The quality of studies was evaluated using the Newcastle-Ottawa Scale (NOS). Odds ratio (OR) for dichotomous values and mean difference (MD) for continuous values were calculated. Patients were divided into minimally invasive spine surgery (MISS) and open subgroups.
Seven retrospective studies reporting 1155 patients and 2309 screws were identified, among which 412 violated the facet joint. Body Mass Index (BMI) ≥ 30 predicted FJV, particularly in the MISS subgroup (OR = 3.73, p < 0.0001). Screw placement at L4 level was associated with lower risk (OR = 0.64, p = 0.0003), while L5 level increased the risk of FJV (OR = 1.85, p < 0.0003). Lower pedicle screw angle (PSA) was another FJV predictor (MD= -5.82, p = 0.0002). In the MIS subgroup, 3D navigation decreased the FJV risk (OR = 0.39, p = 0.001).
BMI ≥ 30, screw placement at L5, and a lower PSA increase the risk of FJV during lumbar interbody fusion. Screw placement at L4 and the use of 3D navigation in MISS are associated with a decreased FJV risk. These findings provide valuable insights for optimizing surgical techniques and reducing FJV incidence in lumbar spine instrumentation.
小关节侵犯（FJV）是脊柱手术中螺钉置入未被充分报道的后果，会显著影响手术节段的承重能力。由于手术技术、导航方法和FJV定义的差异，FJV的发生率在6.3%至100%之间。本研究确定了微创脊柱手术（MISS）和开放手术中腰椎融合时FJV的预测因素。
根据PRISMA指南进行文献综述。使用关键词“MIS”、“微创”、“经皮”、“内镜”、“开放”、“传统”、“常规”、“腰椎融合”、“脊柱融合”、“FJV”、“小关节侵犯”检索PubMed、科学网和Scopus数据库。采用纽卡斯尔-渥太华量表（NOS）评估研究质量。计算二分变量的比值比（OR）和连续变量的平均差（MD）。将患者分为微创脊柱手术（MISS）组和开放手术亚组。
共纳入7项回顾性研究，涉及1155例患者和2309枚螺钉，其中412枚侵犯了小关节。体重指数（BMI）≥30是FJV的预测因素，在MISS亚组中尤为明显（OR = 3.73，p < 0.0001）。L4节段螺钉置入与较低风险相关（OR = 0.64，p = 0.0003），而L5节段增加了FJV风险（OR = 1.85，p < 0.0003）。较低的椎弓根螺钉角度（PSA）是另一个FJV预测因素（MD = -5.82，p = 0.0002）。在MIS亚组中，3D导航降低了FJV风险（OR = 0.39，p = 0.001）。
BMI≥30、L5节段螺钉置入以及较低的PSA会增加腰椎椎间融合时FJV的风险。L4节段螺钉置入以及MISS中使用3D导航与降低FJV风险相关。这些发现为优化手术技术和降低腰椎内固定术中FJV发生率提供了有价值的见解。
