Percutaneous Lumbar Transfacet Screw Fixation: A Technique Analysis of 176 Screws in 83 Patients With Assessment of Radiographic Accuracy, Hardware Failure, and Complications.

Abstract

Transfacet screw fixation can be used to supplement varying techniques of lumbar interbody fusion. The percutaneous placement of transfacet screws represents an alternative to pedicle screws for select cases, which can potentially minimize morbidity. To analyze our experience with respect to accuracy, hardware failure, and neurologic compromise. Clinical records gathered from August 2009 to January 2014 were retrospectively reviewed. We identified 83 patients who underwent placement of 176 consecutive percutaneous transfacet screws while in the prone or lateral position. Accuracy of screw placement was assessed on computed tomography (CT) by entry point and end point. Hardware failure was assessed by radiography or CT. Clinical complications were assessed during regular follow-up visits. Entry point accuracy was 91.4%. Seven cases of intra-articular screw placement and 1 para-articular screw placement were detected on CT. End-point accuracy was 82.8%. There were 16 cases of pedicle breach from 1 to 3 mm on CT. There were 2 screw fractures and 1 case of a Kirschner-wire fracture that were clinically inconsequential. One patient had new nondisabling leg numbness. One patient with new radicular leg pain required removal of a screw. The technique of percutaneous lumbar transfacet screw fixation can be performed accurately and safely with patients in the prone and lateral positions. Entry point inaccuracies were more common at rostral levels due to facet orientation. End-point inaccuracies (pedicle breaches) were more common in the intervertebral foramen where 2 clinical complications occurred.