Spontaneous facet joint fusion and stability assessment following isolated posterior internal fixation for lumbar burst fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FU Xinwei , LI Yuanxuan , CHEN Yao , YANG Chaohua ,  WANG Qing ,  YANG Jin

Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P. R. China;

Corresponding?author：

WANG Qing, Email: wqspine2004@163.com; YANG Jin, Email: 1974374073@qq.com

Keywords：

Spontaneous facet joint fusion; lumbar burst fracture; posterior internal fixation; segmental range of motion

DOI：

10.7507/1002-1892.202511068

Video：

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Objective To investigate the impact of spontaneous facet joint fusion (SFJF) on lumbar motion function following isolated posterior internal fixation for lumbar burst fractures, characterize SFJF radiographically, and explore the indications for implant removal. Methods Patients who underwent implant removal after posterior internal fixation for lumbar burst fractures between January 2018 and September 2024 were retrospectively reviewed. A total of 137 patients (330 segments) met the selection criteria and were enrolled, including 89 males and 48 females, with a median age of 50.0 years (range, 18-71 years). There were 98 patients with two segments, 22 with three segments, and 17 with four segments. Baseline characteristics were included, such as gender, age, AO fracture type, and visual analogue scale (VAS) score for back pain and Oswestry disability index (ODI) at last follow-up. Based on radiographic assessment, facet joint (FJ) fusion was graded as grade 1 (non-fusion), grade 2 (SFJF), or grade 3 (SFJF). Segmental range of motion (ROM) was measured, motion loss rate was calculated, and functional motion status was determined. Intergroup comparisons were performed for baseline characteristics and radiographic parameters. Factors influencing SFJF were analyzed, and the segmental distribution, temporal pattern of SFJF, and its impact on segmental stability were evaluated. Results Postoperative CT revealed that the FJ fusion were rated as grade 1 in 53 patients (190 segments, 57.6%), grade 2 in 49 patients (86 segments, 26.1%), and grade 3 in 35 patients (54 segments, 16.4%). Accordingly, 84 patients (140 segments, 42.4%) were classified as SFJF. Patients with SFJF were younger and had a higher proportion of males, showing significant differences (P<0.05). However, there was no significant difference in AO fracture classification between patients with and without SFJF (P>0.05). At last follow-up, the SFJF patients exhibited higher VAS scores (P<0.05), but no significant difference was observed in ODI (P>0.05). At last follow-up, no significant difference was observed in the distribution of SFJF grades among the 330 segments (P>0.05). The incidence of SFJF increased significantly from 17.9% at 3 months to 39.7% at 6 months postoperatively (P<0.05), with no further significant increase at last follow-up (42.4%, P>0.05). Among SFJF patients with flexion-extension X-ray films, 45 patients with 115 segments were analyzed, including 75 SFJF segments (47 grade 2 and 28 grade 3). Grade 2 and grade 3 segments showed significantly lower ROM than grade 1 segments (P<0.05). Compared with grade 2 segments, grade 3 segments exhibited significantly lower ROM, reduced motion function, and higher motion loss rate (P<0.05). Conclusion The incidence of SFJF following posterior internal fixation for lumbar burst fractures is high, with most fusion processes occurring within the first 6 months after operation. Segmental motion function decreases significantly with increasing fusion grade. Incorporating SFJF assessment into the decision-making process for implant removal in these patients is recommended.

Citation： FU Xinwei, LI Yuanxuan, CHEN Yao, YANG Chaohua, WANG Qing, YANG Jin. Spontaneous facet joint fusion and stability assessment following isolated posterior internal fixation for lumbar burst fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(4): 630-636. doi: 10.7507/1002-1892.202511068 Copy

1.	Li WJ, Guo LX. Influence of different postures under vertical impact load on thoracolumbar burst fracture. Med Biol Eng Comput, 2020, 58(11): 2725-2736.
2.	Dvorak MF, ?ner CF, Dandurand C, et al. Surgical versus non-surgical treatment of thoracolumbar burst fractures in neurologically intact patients: a prospective international multicentre cohort study. Global Spine J, 2026, 16(1): 628-638.
3.	Lai O, Zhang X, Hu Y, et al. Long-segment fixation vs short-segment fixation combined with kyphoplasty for osteoporotic thoracolumbar burst fracture. BMC Musculoskelet Disord, 2022, 23(1): 160. doi: 10.1186/s12891-022-05109-y.
4.	Aono H, Tobimatsu H, Ariga K, et al. Surgical outcomes of temporary short-segment instrumentation without augmentation for thoracolumbar burst fractures. Injury, 2016, 47(6): 1337-1344.
5.	Tromme A, Charles YP, Schuller S, et al. Osteoarthritis and spontaneous fusion of facet joints after percutaneous instrumentation in thoracolumbar fractures. Eur Spine J, 2019, 28(5): 1121-1129.
6.	Izeki M, Fujio K, Ota S, et al. Radiological follow-up of the degenerated facet joints after lateral lumbar interbody fusion with percutaneous pedicle screw fixation: Focus on spontaneous facet joint fusion. J Orthop Sci, 2022, 27(5): 982-989.
7.	Proietti L, Perna A, Ricciardi L, et al. Radiological evaluation of fusion patterns after lateral lumbar interbody fusion: institutional case series. Radiol Med, 2021, 126(2): 250-257.
8.	Gellhorn AC, Katz JN, Suri P. Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol, 2013, 9(4): 216-224.
9.	Wang X, Wu XD, Zhang Y, et al. The necessity of implant removal after fixation of thoracolumbar burst fractures-a systematic review. J Clin Med, 2023, 12(6): 2213. doi: 10.3390/jcm12062213.
10.	Pu X, Wang X, Nie H, et al. Spontaneous facet joint fusion in patients following oblique lateral lumbar interbody fusion combined with lateral single screw-rod fixation: prevalence, characteristics and significance. Eur Spine J, 2022, 31(12): 3580-3589.
11.	Fleming TR. Addressing missing data in clinical trials. Ann Intern Med, 2011, 154(2): 113-117.
12.	Morita T, Yoshimoto M, Emori M, et al. Safe, simple, and valid position for obtaining flexion-extension radiographs to assess instability in patients with lumbar spondylolisthesis: one specific instruction can make a difference. J Neurosurg Spine, 2024, 42(2): 133-139.
13.	Zhang X, Xiao X, Wang H, et al. Comparison of dynesys and hybrid system for multi-segmental LDD. Acta Ortop Bras, 2024, 32(2): e270051. doi: 10.1590/1413-785220243202e270051.
14.	Yamamoto I, Panjabi MM, Crisco T, et al. Three-dimensional movements of the whole lumbar spine and lumbosacral joint. Spine (Phila Pa 1976), 1989, 14(11): 1256-1260.
15.	Liu J, Zhang X, Zhang H, et al. Prevalence, features, and predictive factors of spontaneous spinal arthrodesis in posttraumatic thoracolumbar kyphosis. World Neurosurg, 2024, 185: e676-e682.
16.	Tan S, Yao J, Flynn JA, et al. Zygapophyseal joint fusion in ankylosing spondylitis assessed by computed tomography: associations with syndesmophytes and spinal motion. J Rheumatol, 2017, 44(7): 1004-1010.
17.	Gazzeri R, Panagiotopoulos K, Princiotto S, et al. Spontaneous spinal arthrodesis in stand-alone percutaneous pedicle screw fixation without in situ fusion in patients with lumbar segmental instability: long-term clinical, radiologic, and functional outcomes. World Neurosurg, 2018, 110: e1040-e1048.
18.	Bloemers F, Jug M, Nau C, et al. Thoracolumbar injuries: operative treatment: indications, techniques, timing and implant removal. Current practice. Eur J Trauma Emerg Surg, 2024, 50(5): 1959-1968.
19.	Zhou LP, Zhang RJ, Wang JQ, et al. Medium and long-term radiographic and clinical outcomes of Dynesys dynamic stabilization versus instrumented fusion for degenerative lumbar spine diseases. BMC Surg, 2023, 23(1): 46. doi: 10.1186/s12893-023-01943-6.
20.	Meleis A, Larkin MB, Bastos DCA, 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. doi: 10.3171/2021.1.FOCUS20671.
21.	Kim KW, Ha KY, Moon MS, et al. Fate of the facet joints after instrumented intertransverse process fusion. Clin Orthop Relat Res, 1999, (366): 110-119.
22.	Yamada K, Nagahama K, Abe Y, et al. Unintentional fusion in preserved facet joints without bone grafting after percutaneous endoscopic transforaminal lumbar interbody fusion. Spine Surg Relat Res, 2021, 5(6): 390-396.
23.	Satake K, Kanemura T, Nakashima H, et al. Nonunion of transpsoas lateral lumbar interbody fusion using an allograft: clinical assessment and risk factors. Spine Surg Relat Res, 2018, 2(4): 270-277.
24.	程哲, 何由, 王衛國, 等. 胸腰段爆裂性骨折內固定治療的生物力學特點. 醫用生物力學, 2019, 34(5): 486-492.
25.	Oh HS, Seo HY. Percutaneous pedicle screw fixation in thoracolumbar fractures: comparison of results according to implant removal time. Clin Orthop Surg, 2019, 11(3): 291-296.
26.	Hirahata M, Kitagawa T, Yasui Y, et al. Vacuum phenomenon as a predictor of kyphosis after implant removal following posterior pedicle screw fixation without fusion for thoracolumbar burst fracture: a single-center retrospective study. BMC Musculoskelet Disord, 2022, 23(1): 94. doi: 10.1186/s12891-022-05051-z.
27.	Moon MS, Yu CG, Jeon JM, et al. Usefulness of percutaneous pedicle screw fixation for treatment of lower lumbar burst (A3-A4) fractures: comparative study with thoracolumbar junction fractures. Indian J Orthop, 2023, 57(9): 1415-1422.
28.	Hinojosa-Gonzalez DE, Estrada-Mendizabal RJ, Bueno-Gutierrez LC, et al. A network meta-analysis on the surgical management of thoracolumbar burst fractures: anterior, posterior, and combined. Spine Surg Relat Res, 2023, 7(3): 211-218.
29.	Verheyden AP, Spiegl UJ, Ekkerlein H, et al. Treatment of fractures of the thoracolumbar spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J, 2018, 8(2 Suppl): 34S-45S.
30.	Hanson B, van der Werken C, Stengel D. Surgeons’ beliefs and perceptions about removal of orthopaedic implants. BMC Musculoskelet Disord, 2008, 9: 73. doi 10.1186/1471-2474-9-73.
31.	Reith G, Schmitz-Greven V, Hensel KO, et al. Metal implant removal: benefits and drawbacks-a patient survey. BMC Surg, 2015, 15: 96. doi: 10.1186/s12893-015-0081-6.
32.	Moreira CHT, Krause Neto W, Meves R. Thoracolumbar burst fractures: short fixation, without arthrodesis and without removal of the implant. Acta Ortopédica Brasileira, 2023, 31(spe1): e253655. doi: 10.1590/1413-785220233101e253655.
33.	Jeon CH, Lee HD, Lee YS, et al. Is it beneficial to remove the pedicle screw instrument after successful posterior fusion of thoracolumbar burst fractures? Spine, 2015, 40(11): E627-E633.
34.	Chou PH, Ma HL, Liu CL, et al. Is removal of the implants needed after fixation of burst fractures of the thoracolumbar and lumbar spine without fusion? A retrospective evaluation of radiological and functional outcomes. Bone Joint J, 2016, 98-B(1): 109-116.
35.	Ko S, Jung S, Song S, et al. Long-term follow-up results in patients with thoracolumbar unstable burst fracture treated with temporary posterior instrumentation without fusion and implant removal surgery: Follow-up results for at least 10 years. Medicine (Baltimore), 2020, 99(16): e19780. doi: 10.1097/MD.0000000000019780.
36.	Wu J, Zhu J, Wang Z, et al. Outcomes in thoracolumbar and lumbar traumatic fractures: does restoration of unfused segmental mobility correlated to implant removal time? World Neurosurg, 2022, 157: e254-e263.
37.	El Saman A, Meier SL, Rüger F, et al. Impact of implant removal on quality of life and loss of correction in the treatment of traumatic fractures of the thoracolumbar spine. Brain Spine, 2024, 4: 102845. doi: 10.1016/j.bas.2024.102845.

1. Li WJ, Guo LX. Influence of different postures under vertical impact load on thoracolumbar burst fracture. Med Biol Eng Comput, 2020, 58(11): 2725-2736.
2. Dvorak MF, ?ner CF, Dandurand C, et al. Surgical versus non-surgical treatment of thoracolumbar burst fractures in neurologically intact patients: a prospective international multicentre cohort study. Global Spine J, 2026, 16(1): 628-638.
3. Lai O, Zhang X, Hu Y, et al. Long-segment fixation vs short-segment fixation combined with kyphoplasty for osteoporotic thoracolumbar burst fracture. BMC Musculoskelet Disord, 2022, 23(1): 160. doi: 10.1186/s12891-022-05109-y.
4. Aono H, Tobimatsu H, Ariga K, et al. Surgical outcomes of temporary short-segment instrumentation without augmentation for thoracolumbar burst fractures. Injury, 2016, 47(6): 1337-1344.
5. Tromme A, Charles YP, Schuller S, et al. Osteoarthritis and spontaneous fusion of facet joints after percutaneous instrumentation in thoracolumbar fractures. Eur Spine J, 2019, 28(5): 1121-1129.
6. Izeki M, Fujio K, Ota S, et al. Radiological follow-up of the degenerated facet joints after lateral lumbar interbody fusion with percutaneous pedicle screw fixation: Focus on spontaneous facet joint fusion. J Orthop Sci, 2022, 27(5): 982-989.
7. Proietti L, Perna A, Ricciardi L, et al. Radiological evaluation of fusion patterns after lateral lumbar interbody fusion: institutional case series. Radiol Med, 2021, 126(2): 250-257.
8. Gellhorn AC, Katz JN, Suri P. Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol, 2013, 9(4): 216-224.
9. Wang X, Wu XD, Zhang Y, et al. The necessity of implant removal after fixation of thoracolumbar burst fractures-a systematic review. J Clin Med, 2023, 12(6): 2213. doi: 10.3390/jcm12062213.
10. Pu X, Wang X, Nie H, et al. Spontaneous facet joint fusion in patients following oblique lateral lumbar interbody fusion combined with lateral single screw-rod fixation: prevalence, characteristics and significance. Eur Spine J, 2022, 31(12): 3580-3589.
11. Fleming TR. Addressing missing data in clinical trials. Ann Intern Med, 2011, 154(2): 113-117.
12. Morita T, Yoshimoto M, Emori M, et al. Safe, simple, and valid position for obtaining flexion-extension radiographs to assess instability in patients with lumbar spondylolisthesis: one specific instruction can make a difference. J Neurosurg Spine, 2024, 42(2): 133-139.
13. Zhang X, Xiao X, Wang H, et al. Comparison of dynesys and hybrid system for multi-segmental LDD. Acta Ortop Bras, 2024, 32(2): e270051. doi: 10.1590/1413-785220243202e270051.
14. Yamamoto I, Panjabi MM, Crisco T, et al. Three-dimensional movements of the whole lumbar spine and lumbosacral joint. Spine (Phila Pa 1976), 1989, 14(11): 1256-1260.
15. Liu J, Zhang X, Zhang H, et al. Prevalence, features, and predictive factors of spontaneous spinal arthrodesis in posttraumatic thoracolumbar kyphosis. World Neurosurg, 2024, 185: e676-e682.
16. Tan S, Yao J, Flynn JA, et al. Zygapophyseal joint fusion in ankylosing spondylitis assessed by computed tomography: associations with syndesmophytes and spinal motion. J Rheumatol, 2017, 44(7): 1004-1010.
17. Gazzeri R, Panagiotopoulos K, Princiotto S, et al. Spontaneous spinal arthrodesis in stand-alone percutaneous pedicle screw fixation without in situ fusion in patients with lumbar segmental instability: long-term clinical, radiologic, and functional outcomes. World Neurosurg, 2018, 110: e1040-e1048.
18. Bloemers F, Jug M, Nau C, et al. Thoracolumbar injuries: operative treatment: indications, techniques, timing and implant removal. Current practice. Eur J Trauma Emerg Surg, 2024, 50(5): 1959-1968.
19. Zhou LP, Zhang RJ, Wang JQ, et al. Medium and long-term radiographic and clinical outcomes of Dynesys dynamic stabilization versus instrumented fusion for degenerative lumbar spine diseases. BMC Surg, 2023, 23(1): 46. doi: 10.1186/s12893-023-01943-6.
20. Meleis A, Larkin MB, Bastos DCA, 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. doi: 10.3171/2021.1.FOCUS20671.
21. Kim KW, Ha KY, Moon MS, et al. Fate of the facet joints after instrumented intertransverse process fusion. Clin Orthop Relat Res, 1999, (366): 110-119.
22. Yamada K, Nagahama K, Abe Y, et al. Unintentional fusion in preserved facet joints without bone grafting after percutaneous endoscopic transforaminal lumbar interbody fusion. Spine Surg Relat Res, 2021, 5(6): 390-396.
23. Satake K, Kanemura T, Nakashima H, et al. Nonunion of transpsoas lateral lumbar interbody fusion using an allograft: clinical assessment and risk factors. Spine Surg Relat Res, 2018, 2(4): 270-277.
24. 程哲, 何由, 王衛國, 等. 胸腰段爆裂性骨折內固定治療的生物力學特點. 醫用生物力學, 2019, 34(5): 486-492.
25. Oh HS, Seo HY. Percutaneous pedicle screw fixation in thoracolumbar fractures: comparison of results according to implant removal time. Clin Orthop Surg, 2019, 11(3): 291-296.
26. Hirahata M, Kitagawa T, Yasui Y, et al. Vacuum phenomenon as a predictor of kyphosis after implant removal following posterior pedicle screw fixation without fusion for thoracolumbar burst fracture: a single-center retrospective study. BMC Musculoskelet Disord, 2022, 23(1): 94. doi: 10.1186/s12891-022-05051-z.
27. Moon MS, Yu CG, Jeon JM, et al. Usefulness of percutaneous pedicle screw fixation for treatment of lower lumbar burst (A3-A4) fractures: comparative study with thoracolumbar junction fractures. Indian J Orthop, 2023, 57(9): 1415-1422.
28. Hinojosa-Gonzalez DE, Estrada-Mendizabal RJ, Bueno-Gutierrez LC, et al. A network meta-analysis on the surgical management of thoracolumbar burst fractures: anterior, posterior, and combined. Spine Surg Relat Res, 2023, 7(3): 211-218.
29. Verheyden AP, Spiegl UJ, Ekkerlein H, et al. Treatment of fractures of the thoracolumbar spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J, 2018, 8(2 Suppl): 34S-45S.
30. Hanson B, van der Werken C, Stengel D. Surgeons’ beliefs and perceptions about removal of orthopaedic implants. BMC Musculoskelet Disord, 2008, 9: 73. doi 10.1186/1471-2474-9-73.
31. Reith G, Schmitz-Greven V, Hensel KO, et al. Metal implant removal: benefits and drawbacks-a patient survey. BMC Surg, 2015, 15: 96. doi: 10.1186/s12893-015-0081-6.
32. Moreira CHT, Krause Neto W, Meves R. Thoracolumbar burst fractures: short fixation, without arthrodesis and without removal of the implant. Acta Ortopédica Brasileira, 2023, 31(spe1): e253655. doi: 10.1590/1413-785220233101e253655.
33. Jeon CH, Lee HD, Lee YS, et al. Is it beneficial to remove the pedicle screw instrument after successful posterior fusion of thoracolumbar burst fractures? Spine, 2015, 40(11): E627-E633.
34. Chou PH, Ma HL, Liu CL, et al. Is removal of the implants needed after fixation of burst fractures of the thoracolumbar and lumbar spine without fusion? A retrospective evaluation of radiological and functional outcomes. Bone Joint J, 2016, 98-B(1): 109-116.
35. Ko S, Jung S, Song S, et al. Long-term follow-up results in patients with thoracolumbar unstable burst fracture treated with temporary posterior instrumentation without fusion and implant removal surgery: Follow-up results for at least 10 years. Medicine (Baltimore), 2020, 99(16): e19780. doi: 10.1097/MD.0000000000019780.
36. Wu J, Zhu J, Wang Z, et al. Outcomes in thoracolumbar and lumbar traumatic fractures: does restoration of unfused segmental mobility correlated to implant removal time? World Neurosurg, 2022, 157: e254-e263.
37. El Saman A, Meier SL, Rüger F, et al. Impact of implant removal on quality of life and loss of correction in the treatment of traumatic fractures of the thoracolumbar spine. Brain Spine, 2024, 4: 102845. doi: 10.1016/j.bas.2024.102845.

Chinese Journal of Reparative and Reconstructive Surgery

Spontaneous facet joint fusion and stability assessment following isolated posterior internal fixation for lumbar burst fractures

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