title: Minimally invasive lumbar transfacet screw fixation in the lateral decubitus position after extreme lateral interbody fusion: a technique and feasibility study.
abstract: METHODS
  Prospective evaluation of 10 patients undergoing minimally invasive lumbar interbody fusion for degenerative disk disease and radiculopathy.
  
  
  OBJECTIVE
  To assess the feasibility of percutaneous lumbar transfacet screw fixation in the lateral decubitus position after lateral interbody fusion.
  
  
  BACKGROUND
  Lumbar interbody fusion is commonly performed for the treatment of degenerative disk disease with associated radiculopathy due to foraminal stenosis or disk protrusion. Minimally invasive techniques, such as the lateral interbody fusion, have been developed to achieve this while reducing operative morbidity. Subsequent vertebral fixation is best achieved with a pedicle screw and rod construct in the prone position. Transfacet screw placement has been shown to have near biomechanical equivalence and may reduce operative time and morbidity if placed while the patient remains in the lateral decubitus position.
  
  
  METHODS
  Ten patients with back pain and radicular pain due to single-level degenerative disk disease at L3-L4 or L4-L5 underwent minimally invasive lateral interbody arthrodesis with placement of bilateral percutaneous transfacet screws in the lateral decubitus position. Patients had close perioperative follow-up including recordings of intraoperative blood loss, operative time, and hospital length of stay. Clinical outcome measures including visual analog scores (VAS) were assessed preoperatively and at last follow-up with a minimum of 6 months. Dynamic radiographs were obtained at last follow-up to evaluate the instrumentation and fusion rate.
  
  
  RESULTS
  The procedure was well tolerated by all patients. Mean operative time was 2 hours and 42 minutes. Mean blood loss was 26.5 mL. Mean hospital length of stay was 46.5 hours. Nine of 10 patients had good-to-excellent relief of their preoperative back pain and leg pain. Mean preoperative VAS score for back pain was 8.9 and for leg pain was 8. At a mean follow-up of 8.2 months, mean postoperative VAS score for back pain was 0.9 and for leg pain was 0.9. There were no complications. One patient suffered persistent mild leg dysesthesias. There were no instances of graft or screw dislodgement on follow-up imaging.
  
  
  CONCLUSIONS
  Minimally invasive percutaneous transfacet screw fixation can be performed safely and effectively in the lateral decubitus position. This is an attractive option for posterior percutaneous fixation that can lead to a reduction of operative time and surgical morbidity in select cases.
authors.affiliation: Department of Neurosurgery, Georgetown University Hospital, Washington, DC 20007, USA. jmvoyadzis@gmail.com
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Voyadzis
authors.forename: Amjad Nasr
authors.initials: AN
authors.lastname: Anaizi
mesh_terms: D001863:Bone Screws; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D011446:Prospective Studies; D011859:Radiography; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods