Letter to the Editor. Spontaneous facet fusion
Xingxiao Pu, Shishu Huang, Xiandi Wang, Jiancheng Zeng
2022
Neurosurgical Focus
The article by Meleis et al. 1 is interesting and significant to us (Meleis A, Larkin MB, Bastos DCDA, et al. Single-center outcomes for percutaneous pedicle screw fixation in metastatic spinal lesions: can spontaneous facet fusion occur? Neurosurg Focus. 2021;50[5]:E9). For the phenomenon of spontaneous facet fusion we have some comments, as follows. First, the authors described facet fusion as "the complete union with cartilage reabsorption across the facet joints at the stabilized segments"
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... n the Methods section, and the authors also use Fig. 2 for further illustration. However, the legend to Fig. 2 reads as follows: "Left: Scan obtained immediately postoperatively showing that the joints are not ankylosed." We speculate that the left panel of Fig. 2 should be called a preoperative instead of a postoperative CT scan as described by the authors, because we do not find any postoperative signs including screws and/ or cement. The article also did not mention how to divide patients into the fusion group and the nonfusion group. We are confused whether all of the following categories of patients should be assigned to the fusion group: patients with only unilateral facet joint fusion at any stabilized segment, with bilateral facet joint fusion at any stabilized segment, or with bilateral facet joint fusion at all stabilized segments. We suggest that the fusion status of all facet joints in stabilized segments be discussed separately-in patients with partial joint fusion and in those with fusion in all joints. Second, the article analyzed the factors that influenced the occurrence of spontaneous facet fusion. This could help us identify the causes of this phenomenon so that we can intervene if necessary. However, there were some vital preoperative patient conditions that were not taken into account, including preoperative facet joint osteoarthritis, body mass index, and the existence of spondylolisthesis. 3] [4] As such, the evaluation of spontaneous facet fusion in this article would be more accurate if these updated conditions were applied. Third, facet joint violation (FJV) is important and worthy of consideration. It has been reported that the incidence of FJV after percutaneous pedicle screw fixation was 13.2%. 5 FJV has the possibility to cause spontaneous facet fusion, which should not be ignored. Additionally, INCLUDE WHEN CITING
doi:10.3171/2021.11.focus21701
pmid:35231890
fatcat:4j4gfomg2zbulhrpdrz2kyar2e