Fluoroscopically assisted percutaneous translaminar facet screw fixation following anterior lumbar interbody fusion : Technical report

A technical report of fluoroscopically assisted percutaneous translaminar facet screw fixation after anterior lumbar interbody fusion (ALIF). To describe a minimally invasive translaminar facet screw fixation technique that was modified from the Magerl method, and to assess its technical feasibility and clinical efficacy. There is no previous study in the literature on percutaneous translaminar facet screw fixation assisted only by fluoroscopy without using any specially designed guiding device. Also, there is no previous study involving a screw insertion technique in which the screw is directed to purchase the pedicle while traversing the lamina and transfixing the facet joint. A total of 20 patients with degenerative spinal disease underwent ALIF and supplementary percutaneous translaminar facet screw fixation under fluoroscopic guidance from 2001 through 2002. Their clinical and radiologic data were collected and analyzed. A total of 65 screws were inserted. Seven screws (10.8%) were found to have violated laminae walls but none injured or compressed neural structures directly. The purchases of the facet joints were all successful, but insertion into the pedicle in perfect position was successful in 55 screws (84.6%). Radiologic fusion occurred in all fused levels (100%). Estimated blood loss was 222.5 mL (100-520), and no blood transfusions were needed in any of the cases. There was only one complication related to facet screw fixation, in which the distal tip of a superior articular process was fractured caused by repeated drilling with a K-wire. Percutaneous translaminar facet screw fixation using fluoroscopy is technically feasible. It seems that the fluoroscopically assisted percutaneous translaminar facet pedicle screw fixation is a useful, minimally invasive posterior augmenting method following ALIF.