Abstract
INTRODUCTION: Posterior lumbar fusion is a widely used technique for stabilizing the lumbar spine, yet complications such as cranial facet violations, increased blood loss, and soft tissue trauma have prompted interest in minimally invasive alternatives. Transfacet screw fixation has emerged as a promising technique, offering advantages such as reduced surgical morbidity, lower risk of adjacent segment degeneration, and greater biomechanical stability in specific patient populations. This study investigates the clinical outcomes of patients undergoing one- or two-level lumbar fusion using transfacet screws. METHODS: A retrospective cohort study was conducted on a consecutive series of 31 patients who underwent posterior lumbar fusion using transfacet screws between 2010 and 2022. Patients were included if they received transfacet or translaminar screw fixation at one or two spinal levels and had a minimum of one-year follow-up. Clinical outcomes were evaluated using Oswestry Disability Index (ODI) scores, visual analog scale (VAS) scores for back and leg pain, and clinical data on reoperation rates and indications were evaluated. RESULTS: The mean age of the study population was 53.3 years (range 26-83), and 54.8% were male. Most patients (71%) involved a combined interbody and posterior fusion. A total of 82 screws were implanted across 41 levels, with 48 being translaminar facet screws and 34 being transfacet screws. Patients experienced significant improvements in ODI (40.1 vs. 23.1; p<0.001), back pain (6.4 vs. 2.7; p<0.001), and leg pain (4.7 vs. 2.3; p=0.003) scores. The overall reoperation rate was 19.4% (n=6), with half of these reoperations addressing preexisting pathology rather than surgical failure. Five of the six reoperations (83.3%) involved the use of transfacet screws at additional levels. Time from index to reoperation was shorter on average for continued symptomatic patients (19.7 months) than those who developed symptoms due to new pathologies (49.7 months). CONCLUSION: This study found that the use of transfacet screw fixation provides a viable alternative to traditional pedicle screws, offering significant pain relief and functional improvement.