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Impact of bilateral facet joint violation on radiographic degeneration of superior adjacent segments and clinical outcomes – Lumbar Fusion

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The article explores the effects of facet joint violation (FJV) on postoperative low-back pain and adjacent-segment degeneration in patients who underwent lumbar fusion surgery. The study analyzed data from 148 patients who underwent single-segment minimally invasive transforaminal lumbar interbody fusion and found that FJV, especially bilateral violation, was associated with worsening facet joint and intervertebral disc changes in the superior adjacent segment. This was linked to increased low-back pain and worse functional outcomes in patients with FJV. The study highlights the importance of understanding the mechanisms and impact of FJV on adjacent-segment degeneration

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Published article

S: FJV was associated with postoperative low-back pain and worse functional outcomes. It also aggravated facet joint and intervertebral disc changes in the superior adjacent segment, especially when bilateral violation occurred; this may be part of the mechanisms of adjacent-segment degeneration.

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J Neurosurg Spine. 2024 Apr 5:1-8. doi: 10.3171/2024.1.SPINE23841. Online ahead of print. ABSTRACT OBJECTIVE: Facet joint violation (FJV) is associated with postoperative low-back pain and is a confirmed risk factor for adjacent-segment degeneration, a long-term complication of lumbar fusion surgery. The authors’ knowledge of its mechanisms comes from in vitro biomechanical research only; there is,

J Neurosurg Spine. 2024 Apr 5:1-8. doi: 10.3171/2024.1.SPINE23841. Online ahead of print.

ABSTRACT

OBJECTIVE: Facet joint violation (FJV) is associated with postoperative low-back pain and is a confirmed risk factor for adjacent-segment degeneration, a long-term complication of lumbar fusion surgery. The authors’ knowledge of its mechanisms comes from in vitro biomechanical research only; there is a lack of radiographic evidence of the effects of violation on the superior adjacent-segment facet joint, intervertebral disc, and other local radiographic parameters. Furthermore, any differences between unilateral and bilateral violation remain relatively unclear. The authors therefore aimed to explore the effects of nonviolation and unilateral and bilateral violation on radiographic degeneration of the facet joint and intervertebral disc at the fusion and superior adjacent segment. Patient-reported clinical outcomes were compared at the 2-year follow-up.

METHODS: The authors retrospectively analyzed data from 148 patients with lumbar degenerative diseases who underwent single-segment minimally invasive transforaminal lumbar interbody fusion between 2016 and 2020. FJV and facet joint degeneration were evaluated and graded using Shah’s method and Pathria’s standard, respectively. Radiographic parameters, including disc height and intervertebral Cobb angle at the fusion and superior adjacent segment, were measured. Clinical outcomes were evaluated using visual analog scale (VAS) and Japanese Orthopaedic Association scores.

RESULTS: Preoperative data were comparable among the 3 groups (nonviolation, unilateral violation, and bilateral violation) (p > 0.05). Patient-reported clinical outcomes were followed up for at least 2 years (average duration 28.17 ± 6.17 months). At the last follow-up, facet joint degeneration grades were sequentially increased in the nonviolation, unilateral violation, and bilateral violation groups (p = 0.006). The unilateral (2.45 ± 2.17 mm) and bilateral (2.70 ± 1.94 mm) violation groups had more severe losses of disc height in the superior adjacent segment than did the nonviolation group (1.31 ± 2.01 mm). The VAS low-back pain and Japanese Orthopaedic Association scores in the bilateral (2.57 ± 1.44 and 19.83 ± 2.84, respectively) and unilateral (2.26 ± 0.79 and 20.43 ± 3.85, respectively) violation groups were significantly worse than in the nonviolation group (1.69 ± 1.12 and 21.80 ± 3.36, respectively) (p < 0.05). By contrast, there were no significant between-group differences in disc height, intervertebral Cobb angle in the fusion segment, or VAS leg pain scores (p > 0.05).

S: FJV was associated with postoperative low-back pain and worse functional outcomes. It also aggravated facet joint and intervertebral disc changes in the superior adjacent segment, especially when bilateral violation occurred; this may be part of the mechanisms of adjacent-segment degeneration.

PMID:38579351 | DOI:10.3171/2024.1.SPINE23841

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Impact of bilateral facet joint violation on radiographic degeneration of superior adjacent segments and clinical outcomes

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J Neurosurg Spine. 2024 Apr 5:1-8. doi: 10.3171/2024.1.SPINE23841. Online ahead of print. ABSTRACT OBJECTIVE: Facet joint violation (FJV) is associated with postoperative low-back pain and is a confirmed risk factor for adjacent-segment degeneration, a long-term complication of lumbar fusion surgery. The authors' knowledge of its mechanisms comes from in vitro biomechanical research only; there is

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