Comparison Study On Facet Joint Violation Of Two Approaches During Lumbar Interbody Fusion Of Lumbar Vertebrae

Objectives:To study differences of facet joint violation between Wiltse intermuscular approach and intra-muscular stripping approach in small incision transforaminal lumbar interbody fusion (TLIF) surgery.Study Design:Retrospective study.Patient Sample:Patients who underwent small incision TLIF between June2012and December2014.Outcome Measures:All the patients were underwent the postoperative computed tomography (CT) scans to evaluate the facet joint violation.Methods:This study consisted of a consecutive series of101patients undergoing small incision TLIF at a single institution for unilateral lumbar degenerative disease. The decompression side of all patients adopted intra-muscular stripping approach; for the non decompression side, all patients adopted Wiltse intermuscular approach. Routine postoperative CT was obtained and evaluated for violation of the facet joint.Results:101consecutive patients (452pedicle screws) met the study criteria and were included in the study, including79single-level fusions,20two-level fusions and2three-level fusions. The incidence of the violations of Wiltse intermuscular approach and intra-muscular stripping approach is26.55%and35.40%. The incidence of the violations of L3, L4, L5and S1segment is16.67%,20.25%,34.90%and56.45%.Conclusion:The Wiltse intermuscular approach can improve the accuracy of the pedicle screw placement and caused less violation of the facet joint than intra-muscular stripping approachand. Furthermore, more care should be taken to avoid violation of the facet joint when small incision TLIF surgery is considered at the L5and S1segment.