Risk factors for facet joint violation in minimally invasive and open lumbar interbody fusion: a systematic review and meta-analysis

Natalia Anna Koc; Piotr Oleksy; Maciej Szyduczyński; Michał Krakowiak; Tomasz Szmuda; Piotr Zieliński; Grzegorz Miękisiak

doi:10.1007/s00586-025-09015-4

Risk factors for facet joint violation in minimally invasive and open lumbar interbody fusion: a systematic review and meta-analysis

Eur Spine J. 2025 Jun 9. doi: 10.1007/s00586-025-09015-4. Online ahead of print.

Authors

Natalia Anna Koc¹, Piotr Oleksy², Maciej Szyduczyński³, Michał Krakowiak³, Tomasz Szmuda³, Piotr Zieliński³, Grzegorz Miękisiak⁴

Affiliations

¹ Medical University of Gdańsk, Gdańsk, Poland. nataliaannakoc@gumed.edu.pl.
² Medical University of Silesia, Katowice, Poland.
³ Medical University of Gdańsk, Gdańsk, Poland.
⁴ Orthos Hospital, Komorowice, Poland. gmiekisiak@gmail.com.

PMID: 40488873
DOI: 10.1007/s00586-025-09015-4

Abstract

Purpose: Facet joint violation (FJV) is an underreported consequence of screw placement in spine surgery, significantly impacting load-bearing capability of the level. Rates of FJV range from 6.3 to 100% due to variability in surgical techniques, navigation methods, and FJV definitions. This study identifies FJV predictors during lumbar fusion in minimally invasive spine surgery (MISS) and open procedures.

Methods: Literature review was performed according to PRISMA guidelines. PubMed, Web of Science and Scopus were searched using keywords "MIS", "minimally invasive", "percutaneous", "endoscopic", "open", "conventional", "traditional", "lumbar fusion", "spine fusion", "FJV", "facet joint violation". The quality of studies was evaluated using the Newcastle-Ottawa Scale (NOS). Odds ratio (OR) for dichotomous values and mean difference (MD) for continuous values were calculated. Patients were divided into minimally invasive spine surgery (MISS) and open subgroups.

Results: Seven retrospective studies reporting 1155 patients and 2309 screws were identified, among which 412 violated the facet joint. Body Mass Index (BMI) ≥ 30 predicted FJV, particularly in the MISS subgroup (OR = 3.73, p < 0.0001). Screw placement at L4 level was associated with lower risk (OR = 0.64, p = 0.0003), while L5 level increased the risk of FJV (OR = 1.85, p < 0.0003). Lower pedicle screw angle (PSA) was another FJV predictor (MD= -5.82, p = 0.0002). In the MIS subgroup, 3D navigation decreased the FJV risk (OR = 0.39, p = 0.001).

Conclusion: BMI ≥ 30, screw placement at L5, and a lower PSA increase the risk of FJV during lumbar interbody fusion. Screw placement at L4 and the use of 3D navigation in MISS are associated with a decreased FJV risk. These findings provide valuable insights for optimizing surgical techniques and reducing FJV incidence in lumbar spine instrumentation.

Keywords: Adjacent segment disease; Facet joint violation; Lumbar spine fusion; Meta-analysis; Minimally invasive spine surgery.

Publication types

Review