title: Analysis of risk factors for adjacent superior vertebral pedicle-induced facet joint violation during the minimally invasive surgery transforaminal lumbar interbody fusion: a retrospective study.
abstract: BACKGROUND
  The purpose was to explore possible risk factors of facet joint violation induced by adjacent superior vertebral pedicle screw during the minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF).
  
  
  METHODS
  A total of 69 patients with lumbar degenerative disease, who underwent MIS-TLIF were retrospectively reviewed. Postoperative computed tomography images were used to assess the facet joint violation. The correlation of facet joint violations with gender, age, body mass index (BMI), the adjacent superior vertebral level, fusion segment numbers, position of screw insertion, straight leg-raising test (SLRT) results, clinical diseases and renal dysfunction were analyzed by Chi-square tests and binary logistic regression analysis.
  
  
  RESULTS
  The incidence of adjacent superior facet joint violations was 25.4 %. Chi-square test showed the patients with age <60 and high BMI (≥30 kg/m(2)) were more prone to have facet joint violations (P = 0.007; P = 0.006). The single segment fusion presented more facet joint violations than the double segments fusion (P = 0.048). The vertebral pedicle screw implant location at L5 showed more facet joint violations compared with that at L3 and L4 (P = 0.035). No correlation was found between gender, screw implant position, SLRT results, clinical diseases and renal dysfunction and facet joint violations. Logistic regression analysis revealed that age <60 years (OR: 2.902; 95 % CI 1.227-6.864; P = 0.015) and BMI ≥30 kg/m(2) (OR: 2.825; 95 % CI 1.191-6.700; P = 0.018 < 0.05) were significantly associated with facet joint violation.
  
  
  CONCLUSIONS
  These results found a high incidence of adjacent superior vertebral facet joint violation in the MIS-TLIF. Age <60 and BMI ≥30 kg/m(2) might be risk factors of facet joint violation. Evidence level: Level 4.
authors.affiliation: Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, China. zzl995766@sina.com.
authors.forename: Zhi-Li
authors.initials: ZL
authors.lastname: Zeng
authors.affiliation: Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, China. jialong19880523@163.com.
authors.forename: Long
authors.initials: L
authors.lastname: Jia
authors.affiliation: Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, China. lorings@126.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.affiliation: Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, China. yuyan_83@hotmail.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, China. xueshenhuxiao@163.com.
authors.forename: Xiao
authors.initials: X
authors.lastname: Hu
authors.affiliation: Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, China. jyongwei@yahoo.com.cn.
authors.forename: Yong-Wei
authors.initials: YW
authors.lastname: Jia
authors.affiliation: Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, China. wjj034370@163.com.
authors.forename: Jian-Jie
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Department of Spine Surgery, Tongji Hospital, Tongji University School of Medicine, 389 Xincun Road, Shanghai, China. chlm.d@163.com.
authors.forename: Li-Ming
authors.initials: LM
authors.lastname: Cheng
mesh_terms: D015992:Body Mass Index; D005260:Female; D006801:Humans; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000706:statistics & numerical data; D065289:Pedicle Screws / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed; D021801:Zygapophyseal Joint / Q000503:physiopathology / Q000601:surgery