Animal Models and Imaging of Intervertebral Disc Degeneration
Raquel M. Gonçalves, Mário Adolfo Barbosa in Gene and Cell Delivery for Intervertebral Disc Degeneration, 2018
Facetectomy is the removal of a caudal articular process (facet) of a vertebra in order to induce joint destabilization. It can be unilateral or bilateral. Torsional injury after facetectomy in the rabbit has been shown to induce progressive (around 3 months) DDD with a decrease in NP volume accompanied by increased phospholipase A2 levels, indicating inflammation that was not observed with facetectomy alone (Hadjipavlou et al. 1998). Yet facetectomy alone in the lumbar spine of immature white rabbits (Sullivan, Farfan, and Kahn 1971) triggers a decrease in IVD height with thinning of the posterior AF and disorganization of the NP after 6 months. Mechanical instability by resection of the spinal process in mice also seemed effective in inducing disc degeneration in the cervical spine with proliferation of cartilaginous tissue and fissures in the AF, shrinkage of the NP, disc herniation, and osteophytic formation (Miyamoto, Yonenobu, and Ono 1991). It is interesting to note that instability is less efficient in inducing degeneration in the lumbar spine than in the cervical spine. This is probably due to the different muscular environments that can counteract the induced destabilization.
Minimally Invasive Transforaminal Lumbar Interbody Fusion
Alexander R. Vaccaro, Christopher M. Bono in Minimally Invasive Spine Surgery, 2007
The next step in the procedure is performing the facetectomy. The soft tissue over the facet is removed with a bovie cautery and rongeurs. The facet–lamina junction is delineated using curettes. Using an angled curette, the space between the lamina and the ligamentum flavum is defined. Using the Kerrison rongeur, the lamino–facet junction is removed. If there is no stenosis, then a small laminotomy can be done to allow the visualization of the neural elements in close proximity to the facet joint. If the patient has stenosis on the ipsilateral side, a complete laminectomy should be performed. In cases of bilateral stenosis, the spinous process can be undercut and a contralateral laminectomy and facetectomy accomplished. If stenosis is severe or there is a significant foraminal component on the contralateral side, we suggest direct decompression. Using a combination of Kerrison rongeurs and osteotomes, the facet joint is removed. The fragments of bone should be saved for autologous bone grafting. A burr may be used to remove the facet joint but this decreases the quantity of bone graft.
The Closing Wedge Osteotomy for Thoracolumbar Deformity in Ankylosing Spondylitis
Barend J. van Royen, Ben A. C. Dijkmans in Ankylosing Spondylitis Diagnosis and Management, 2006
After a wide midline decompression, remaining posterior elements (the superior facet, the inferior facet, and the pars) of the vertebra to be osteotomized are removed. During the removal of the superior facet, the medial half of the transverse process is removed to permit access to the lateral wall of the vertebral body. Extension of the facetectomy to include a portion of the inferior facet of the level above and a portion of the superior facet of the level of the pedicle below effectively creates a single foramen shared by the nerve root above the osteotomy and the nerve root at the level of the osteotomy. After removal of the posterior elements, the remaining pedicle is visible as are the nerve roots above and below (Fig. 3). Fat and perineurium should be left around the nerve roots during this exposure. Hemostasis is maintained by bipolar electrocautery. We have found the Floseal Matrix Hemostatic Sealant (Baxter International, Jersey City, New Jersey, U.S.) and bovine collagen matrices to be useful in the maintenance of hemostasis during the bony resection portion of the procedure.
Device solutions for a challenging spine surgery: minimally invasive transforaminal lumbar interbody fusion (MIS TLIF)
Published in Expert Review of Medical Devices, 2019
Arash J. Sayari, Dil V. Patel, Joon S. Yoo, Kern Singh
Using fluoroscopic guidance to localize the level of interest, a 2–3 cm incision is made just lateral to the pedicle on the side of the pathology. A symmetric incision can be made on the contralateral side if bilateral instrumentation is planned. Next, a Jamshidi needle (CareFusion, San Diego, CA) is advanced to the intersection of the transverse process and the facet complex, located at the 2 o’clock and 10 o’clock positions for the right and left pedicles, respectively. After guidewire placement, sequential dilators are placed to increase visualization of the lamina, pars interarticularis, and facet capsule. Using a high-speed burr, a unilateral or bilateral laminectomy is performed. Meanwhile, a suction trap is used to salvage bone dust, which acts as a bulking agent in the disc space or adjunct in the interbody cage [21]. Wide decompression and exposure are complete when the pars is resected in line with the inferior aspect of the superior endplate. A facetectomy is then performed with removal of the superior and inferior articular processes. Osteotomes can lend themselves as useful during laminectomy and facetectomy, especially in helping obtain further autograft [22]. Resection of the ligamentum flavum is the final step of the decompression, which should include contralateral decompression when appropriate.
Endoscopic transforaminal lumbar interbody fusion: a comprehensive review
Published in Expert Review of Medical Devices, 2019
Yong Ahn, Myung Soo Youn, Dong Hwa Heo
Some characteristics are common across the three reported techniques. First, all strategies generally involve a posterolateral transforaminal approach with either total or partial facetectomy. Second, visualization is obtained through an endoscopic system rather than through an operating microscope. Third, the decompression procedure is similar to that used in MIS-TLIF, regardless of the type of endoscope used. However, endoscopic TLIF and MIS-TLIF differ in terms of some key features. First, endoscopic TLIF requires a smaller skin incision with less muscle dilation, though there is no evidence that this actually results in less pronounced muscle trauma. Second, endoscopic TLIF allows more flexibility in terms of the method of anesthesia. Unlike MIS-TLIF, endoscopic TLIF can be performed under local anesthesia or conscious sedation, which is a unique benefit of endoscopic TLIF. Third, despite these advantages, the indication of endoscopic TLIF may be limited to degenerative stenosis with low-grade spondylolisthesis, whereas MIS-TLIF is more appropriate for deformity correction or reduction of vertebral slippage in high-grade spondylolisthesis. Finally, the optimal instrumentation technique to accomplish solid fusion or stabilization of the vertebral segment in endoscopic TLIF has yet to be established.
Mid thoracic intra-spinal facet cyst with lumbar canal stenosis: a rare ‘double crush’
Published in International Journal of Neuroscience, 2023
Abhinandan Reddy Mallepally, Nandan Marathe, Jeevan Kumar Sharma, Bibhudendu Mohaptra, Kalidutta Das
Intralesional or epidural steroid injections are reported to provide temporary relief [16, 19,20] owing to anti-inflammatory action of steroids. Although, CT-guided aspiration frequently utilized in the lumbar region has not been reported in dorsal spine cysts owing to narrow canal and concern regarding myelopathy. Symptomatic radiculopathy and myelopathy call for surgical decompression. [21]. But the optimal surgical strategy remains controversial. Though laminectomy and medial facetectomy is recommended, iatrogenic instability is a matter of concern. Hence fusion is suggested when wide decompression is performed. Operating surgeon must plan instrumented fusion in addition to the decompression based on assessment of instability, degree of degeneration of the segment, and associated axial pain.
Related Knowledge Centers
- Surgery
- Spinal Decompression
- Dorsal Root of Spinal Nerve
- Intervertebral Foramen