Mini-invasive bilateral transfacet screw fixation with reconstruction of the neural arch for lumbar stenosis: A two centre case series

Background and purpose: Lumbar stenosis and instability frequently coexist. Spinal canal decompression is often combined with fixation of the relevant vertebral segment and can be performed using different techniques and devices, including pedicle screws and inter-spinous devices and facet screws. The present study evaluates the clinical outcome of laminectomy and single-level fusion using a minimally invasive technique for rigid pos-terior spinal column fixation with two cross-linked lag screws.Methods: The records of patients operated from 2012 to 2016 were retrieved from the computerised medical record database system. Data on age, sex, surgical level, type of deficit and disease were collected. The Oswestry Disability Index (ODI) and Short Form-36 (SF-36) questionnaires were administered pre-operatively and at 1, 6, 12 and 24 months after surgery.Main findings: A total of 46 consecutive patients were operated between January 2012 to October 2016. One intraoperative complication was reported, and 4 patients experienced radiographic pseudarthrosis postoperatively. Five patients underwent additional surgery. The lumbar and lower limb VAS score, ODI and SF-36 scores showed statistically significant improvement for each score at the first and last follow-up (p < 0.01).Conclusion: Percutaneous lumbar transfacet screw placement with the Facet-Link (R) system is feasible and safe but with a relatively high rate of poor articular fusion. This technique can reduce the morbidity of single-level lumbar spinal stenosis and mild instability and improve patient outcome scores. Comparative studies, including randomised controlled trials, are needed to confirm these findings.(c) 2021 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.