Clinical efficacy of lumbar and lumbosacral fusion using the Boucher facet screw fixation technique

Abstract

The clinical outcome of posterolateral lumbar and lumbosacral fusions with facet screw fixation using the Boucher technique is reviewed retrospectively. The Boucher technique uses AO cortical screws that traverse the facet joint at an angle from the superior lamina, in a medial to lateral direction, to enter the respective inferior pedicle. The procedure was performed on 57 consecutive patients who had a degenerative disk disease. The pre-operative diagnosis was based on a physical examination and radiographs with myelography performed when deemed necessary. Surgery had been indicated and performed on patients with unresolved pain after 6 months of conservative therapy; radiographic signs of disk space narrowing, facet arthrosis, degenerative spondylolisthesis or instability on flexion and extension views. No prior history of spinal surgery, no involvement in any litigation or Workers Compensation process, and no detected psychiatric disturbances were also inclusion criteria for this study. Eighteen consecutive male and 39 consecutive female patients were included in the study. The average age at the time of surgery was 41.8 years. The mean active clinical follow-up (office visits) time was 5.06 months with the minimum follow-up time of 3 months. Two years after their surgery, all the patients were asked to fill out a questionnaire from which their progress was evaluated. All questionnaires were completed and returned. Postoperatively, patients were placed in either a lumbosacral corset, short rigid lumbosacral molded polypropylene brace or body cast. Overall clinical results for single level fusions showed that 91.2% of patients (31 of 34) had excellent results and 8.8% (3 of 34) had poor results. Of the multiple level fusions, 86.4% of patients (19 of 22) had excellent or good results and 9.1% (2 of 22) had poor results. Post-operative complications included only three wound infections at the iliac crest donor site. This study demonstrates that facet screw fixation using the Boucher technique has advantages. The technique not only is easy to implement by placing a small screw through a facet joint and it's respective pedicle, but produces excellent clinical results that are comparable to the other more bulky spinal instrumentation systems.