Instrumented Facet Fusion in the Lumbosacral Spine: Long-Term Clinical and Radiographic Results

초록

OBJECTIVE: Surgical treatments for degenerative lumbar spinal disorders involve decompression of neural structures and arthrodesis to address pain from unstable inter- vertebral segments. Lumbar instrumented facet fusion (IFF), a less invasive technique, has shown positive short-term outcomes, but reports on its long-term outcomes are scarce. This study aims to report its long-term biomechanical stability and clinical outcomes. METHODS: This single-center retrospective observational case series included patients who underwent single- or two-level IFF for degenerative lumbar spinal disorders from January 1996 to January 2021. Patient demographics, Oswestry Disability Index and visual analog scale scores, and radiographic fusion were assessed using flexion-extension radiographs and CT scans. Instrument failures and fusion segment angles were measured. RESULTS: A total of 494 patients underwent IFF during the studied period. Of those, 208 were followed up for more than 24 months (mean follow-up of 89.96 +/- 55.59 months). The overall fusion rate was 92.05%. Revision surgery due to adjacent segmental disease was done in 11.06% of patients. Screw loosening was observed in 6 patients, of whom 2 underwent revision surgery. Significant improvements in Oswestry Disability Index and visual analog scale were observed. CONCLUSIONS: IFF is a safe and less invasive alternative method of lumbar spinal arthrodesis with a comparable fusion rate and clinical outcome. This method shows a relatively low revision rate.

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