Introduction: Although facet joint violation (FJV) during lumbar fusion has been recognized as a potential risk factor for adjacent segment disease, there is inconclusive data clarifying the true clinical implications of FJV. In the current study, we seek to illuminate the impact of superior segment FJV on reoperation rate and quality of life (QOL).

Methods: Patients who underwent lumbar fusion surgery between 2009 and 2013 with postoperative computed tomography imaging were included. Patients were placed in the FJV group if either of the superior segment facet joints were compromised, while patients with preserved facet joints were placed in the control group. Demographic, perioperative, and one-year QOL data were collected for both the FJV and control groups.

Results: Of the 241 patients included, 112 patients were found to have FJV and the remaining 129 patients were placed in the control group. One year following lumbar fusion, reoperation rates were similar between the FJV and control groups (p=0.53). At two-year follow-up, the reoperation rate in the FJV group was significantly higher than in the control group (17.0% and 7.8%, respectively; p=0.02). Multivariate logistic regression analysis showed FJV to be the only independent predictor of reoperation two years postoperatively (p=0.03), with an odds ratio of 2.53 (95% CI: 1.11-6.15). No significant difference was observed between the two groups in regards to 1-year postoperative Pain Disability Questionnaire, EuroQOL 5 Dimensions, or Patient Health Questionnaire-9 scores (p=0.97, p=0.24, and p=0.79, respectively).

Conclusions: This study is the first quantification of the impact of facet joint violation on reoperation rate and quality of life. We found that FJV does not lead to any change in reoperation rate or quality of life scores within one year following lumbar fusion surgery. However, FJV was found to be an independent predictor of reoperation two years postoperatively.

Patient Care: This study supports placement of pedicle screws with a more inferolateral starting point so to avoid compromising the superior-level facet joint during instrumented lumbar fusion. This could lower the rate of reoperation in patients undergoing lumbar fusion, thereby improving clinical outcomes.

Learning Objectives: By the conclusion of this session, participants should: 1) Appreciate the negative impact facet joint violation has on patient outcomes, 2) Identify the most effective pedicle screw insertion point to avoid facet joint compromise.

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