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  • Instrumented Versus Non-instrumented Minimally Invasive Lumbar Fusion: Using Facet Joint Morphometric Analysis to Facilitate Decision-Making

    Final Number:

    Mick J. Perez-Cruet MD MS; Elizabeth Abel BS; Alan Xi; Lana Grasser

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Low back pain (LBP) is a common reason for seeking help from a physician. Despite the understanding of facet pathomorphology, few studies have shown how pre-operative morphometric facet analysis can be used to decide whether decompression versus decompression with instrumented fusion is necessary. Currently many surgeons use the flexion extension plain radiograph to help make this decision. This study analyzes the efficacy of pre-operative facet pathomorphology to decide the optimal surgical approach.

    Methods: Included 119 patients (58M, mean age 61) with various degenerative abnormalities of the spine (i.e., stenosis, neural claudication, spondylolisthesis, retrolisthesis, etc.) who underwent minimally invasive decompression with or without minimally invasive instrumented fusion. Morphometric data was gathered from pre-operative MRIs and CTs of the lumbosacral spine and analyzed in terms of facet morphology, disease presentation, and severity of progression. Bilateral superior and inferior facets were measured for length and area; total area was also taken for the joint bilaterally. Non-operative level facets were used for controls.

    Results: Facet length and area were found to be significantly longer (2.6 +/- 0.4 cm) than controls (1.6 +/- 0.3 cm) for those patients who required decompression with instrumented fusion, compared to those who required decompression without instrumented fusion. Patients who received decompression without instrumented fusion showed facet levels that were markedly similar to normal levels, showing very little hypertrophy.

    Conclusions: Data in this study suggest that patients with elongated facets are appropriate indication for choosing decompression with instrumented fusion. Whereas those patient with facet morphology similar to non-surgical control level can be managed with decompression alone. Thus pre-operative facet analysis can add additional decision making information aside from plain flexion extension radiographs.

    Patient Care: This will allow surgeons to choose the safest and more effective method of treatment for their patients.

    Learning Objectives: To create a reliable methodology for determining the appropriate surgical procedure for individualized treatment.

    References: American Association of Neurosience Nurses. (n.d.). Lumbar Spine Surgery A Guide to Preoperative and Postoperative Patient Care. Glenview, IL: AANN. Hsiang, J. K., MD, PhD, & Furman, M. B., MD, MS. (2015, July 9). Spinal Stenosis. Retrieved March 21, 2016, from Khan, N. R., Clark, A. J., Lee, S. L., Venable, G. T., Rossi, N. B., & Foley, K. T. (2015). Surgical Outcomes for Minimally Invasive vs Open Transforaminal Lumbar Interbody Fusion. Neurosurgery, 77(6), 847-874. Retrieved from Lee, W., Park, J., Kim, K. H., Kuh, S. U., Chin, D. K., Kim, K. S., & Cho, Y. E. (2016). Minimally Invasive Transforaminal Lumbar Interbody Fusion in Multilevel: Comparison with Conventional Transforaminal Interbody Fusion. World Neurosurgery, 85, 236-243. Retrieved from Levin, K. H. (2010). Low Back Pain. Disease Mangement. Retrieved from Mobbs, R. J., Li, J., Sivabalan, P., Raley, D., & Rao, P. J. (2014). Outcomes after decompressive laminectomy for lumbar spinal stenosis: Comparison between minimally invasive unilateral laminectomy for bilateral decompression and open laminectomy. Journal of Neurosurgery: Spine, 21(2), 179-186. Retrieved from White AA, Panjabi MM. Clinical biomechanics of spine. Abnormal flexion-extension mobility - Paradoxical motion. Kinematics of Spine Chap. 2; 89.;year=2003;volume=37;issue=1;spage=2;epage=2;aulast=Ingalhalikar

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