title: Percutaneous facet screw fixation of lumbar spine with CT and fluoroscopic guidance: a feasibility study.
abstract: OBJECTIVE
  To assess the feasibility of computed tomography (CT)- and fluoroscopy-guided percutaneous facet screw fixation following anterior lumbar interbody fusion (ALIF) or anterior pseudarthrosis in adults.
  
  
  METHODS
  Institutional review board approval and informed consent were obtained for this study. One hundred seven consecutive adult patients (46 men, 61 women; mean age ± standard deviation: 56.3 years ± 12.9) with ALIF (n = 79) or anterior pseudarthrosis (n = 28) were prospectively treated by means of percutaneous facet screw fixation with CT and fluoroscopic guidance. Two 4.0-mm cannulated screws were placed per level to fix facet joints by using either a translaminar facet or transfacet pedicle pathway. Only local anesthesia was used during these procedures. Procedural time was noted for each patient. Postoperative follow-up ranging from 1 year to 3 years was assessed by using Macnab and radiologic criteria.
  
  
  RESULTS
  The mean procedure times for a lumbar single-level and a double-level fusion ranged from 15 to 25 minutes and from 40 to 50 minutes, respectively. All the transfacet pedicle (n = 182) and translaminar facet (n = 56) screws were successfully placed in one attempt. Radiographic fusion was observed within the year following posterior fixation in all patients despite one translaminar screw failure. According to the Macnab criteria, the clinical results were classified as excellent in 92 (86%) and good in 15 (14%) of 107 patients at the time of their last follow-up examination.
  
  
  CONCLUSIONS
  This feasibility study showed that CT- and fluoroscopy-guided percutaneous facet screw fixation is a rapid, safe, and effective method.
authors.affiliation: Departments of Radiology, Hôpital Archet 2, Teaching Hospital of Nice, 151 route Saint-Antoine de Ginestière, 06200 Nice, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Amoretti
authors.forename: Marie-Eve
authors.initials: ME
authors.lastname: Amoretti
authors.forename: Istvan
authors.initials: I
authors.lastname: Hovorka
authors.forename: Olivier
authors.initials: O
authors.lastname: Hauger
authors.forename: Pascal
authors.initials: P
authors.lastname: Boileau
authors.forename: Laurent
authors.initials: L
authors.lastname: Huwart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000379:methods*; D013123:Spinal Fusion / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome