Lumbar vertebropexy after unilateral total facetectomy

Anna-Katharina Calek; Jonas Widmer; Marie-Rosa Fasser; Mazda Farshad

doi:10.1016/j.spinee.2023.07.005

Lumbar vertebropexy after unilateral total facetectomy

Spine J. 2023 Nov;23(11):1730-1737. doi: 10.1016/j.spinee.2023.07.005. Epub 2023 Jul 13.

Authors

Anna-Katharina Calek¹, Jonas Widmer², Marie-Rosa Fasser², Mazda Farshad³

Affiliations

¹ Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland; Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Lengghalde 5, CH-8008, Zurich, Switzerland. Electronic address: anna-katharina.calek@balgrist.ch.
² Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Lengghalde 5, CH-8008, Zurich, Switzerland.
³ Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland; University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.

PMID: 37451550
DOI: 10.1016/j.spinee.2023.07.005

Abstract

Background context: Posterior decompression with spinal instrumentation and fusion is associated with well-known complications. Alternatives that include decompression and restoration of native stability of the motion segment without fusion continue to be explored, however, an ideal solution has yet to be identified.

Purpose: The aim of this study was to test two different synthetic lumbar vertebral stabilization techniques that can be used after unilateral total facetectomy.

Study design: Biomechanical cadaveric study.

Methods: Twelve spinal segments were biomechanically tested after unilateral total facetectomy and stabilized with a FiberTape cerclage. The cerclage was pulled through the superior and inferior spinous process (interspinous technique) or through the spinous process and around both laminae (spinolaminar technique). The specimens were tested after (1) unilateral total facetectomy, (2) interspinous vertebropexy and (3) spinolaminar vertebropexy. The segments were loaded in flexion-extension (FE), lateral shear (LS), lateral bending (LB), anterior shear (AS) and axial rotation (AR).

Results: Unilateral facetectomy increased native ROM in FE by 10.6% (7.6%-12.6%), in LS by 25.8% (18.7%-28.4%), in LB 7.5% (4.6%-12.7%), in AS 39.4% (22.6%-49.2%), and in AR by 27.2% (15.8%-38.6%). Interspinous vertebropexy significantly reduced ROM after unilateral facetectomy: in FE by 73% (p=.001), in LS by 23% (p=.001), in LB by 13% (p=.003), in AS by 16% (p=.007), and in AR by 20% (p=.001). In FE and LS the ROM was lower than in the baseline/native condition. In AS and AR, the baseline ROM was not reached by 17% and 1%, respectively. Spinolaminar vertebropexy significantly reduced ROM after unilateral facetectomy: in FE by 74% (p=.001), in LS by 24% (p=.001), in LB by 13% (p=.003), in AS by 28% (p=.004), and in AR by 15 % (p=.001). Baseline ROM was not reached by 9% in AR.

Conclusion: Interspinous vertebropexy seems to sufficiently counteract destabilization after unilateral total facetectomy, and limits range of motion in flexion and extension while avoiding full segmental immobilization. Spinolaminar vertebropexy additionally restores native anteroposterior stability, allowing satisfactory control of shear forces after facetectomy.

Clinical significance: Lumbar vertebropexy seems promising to counteract the destabilizating effect of facetectomy by targeted stabilization.

Keywords: Facetectomy; Lumbar fusion; Lumbar spine; Semi-rigid; Spinal stabilization; Vertebropexy.