Eur J Musculoskel Dis 2022 Jan-Apr;11(1):23-29
EVALUATION STUDY
TREATING THE MICRO INSTABILITY WITH PERCUTANEOUS CT GUIDED TRANSFACETAL FIXATION: A 15-YEAR EXPERIENCE
L. Manfrè1, A.E. De Vivo2, H. M. Alqatani3, J. Hirsh4, B. Beomonte Zobel5, M. Midiri6 and M. Bonetti6
1Minimal Invasive Spine Therapy Department, Mediterranean Institute for Oncology, Viagrande, Catania, Italy;
2Department of Radiology, Campus BioBiomedicaliversity, Roma, Italy;
3Department of Neuroradiology, Hamad General Hospital, Doha, Qatar;
4Department of Neuroradiology, General Massachusetts Hospital MAsGEn, Boston, U.S.
5Department of Radiology, University of Palermo, Palermo, Italy;
6Department of Neuroradiology, Istituto Clinico Città di Brescia, Brescia, Italy
Correspondence to:
Dr Luigi Manfrè, MD
Minimal Invasive Spine Therapy Department,
Mediterranean Institute for Oncology,
Corso Italia 10,
95129 Catania, Italy
e-mail: lmanfre@me.com
|
Received: 07 January, 2022
Copyright: |
ISSN: 2038-4106 This publication and/or article is for individual use only and may not be further reproduced without written permission from the copyright holder. Unauthorized reproduction may result in financial and other penalties. Disclosure: All authors report no conflicts of interest relevant to this article.
|
ABSTRACT
Axial microinstability secondary to disc degeneration and consequent chronic facet joint syndrome (CFJS) is a well-known pathological entity, usually responsible for low back pain (LBP). Despite posterior lumbar fixation has been widely used for lumbar spine instability and LBP, a complication related to wrong screw introduction, perineural scars, and extensive muscle dissection leading to muscle dysfunction has been described. Radiofrequency ablation of facet joints zygapophyseal nerves conventionally used for pain treatment fails in approximately 21% of patients. We investigated the “covert-surgery” minimally invasive technique in treating local spinal instability and LBP, using a novel fully-CT-guided approach in patients affected by axial instability and complicated by CFJS resistant to radio ablation. We introduced fully- or partially-treated trans-facet screws directly to achieve solid arthrodesis, reducing instability and LBP, thus a retrospective study was performed. All patients in simple analogue sedation perfectly tolerated the CT-guided procedure, and the mean operative time was approximately 45 minutes only. All 67 patients treated underwent clinical and CT study follow-up at 2 months, revealing LBP disappearance in 50 patients and a significant reduction of lumbar pain in 17 patients. In conclusion, CT-guided trans-facet screws is a fast and safe technique when posterior facet fixation is needed.
KEYWORDS: spine, instability, fixation, CT
