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Peer-reviewedCC BYFrontiers in surgery

Facet joint fusion in lumbar surgery: a biomechanical review of posterior column preservation and reconstruction.

  • Tong Xu1
  • Xingyu Zhao1
  • Lei Zhang1
  • Kai Wang1
  • Zhenlei Liu1
  • Shaocheng Liu2
  • He Wang1
  • Yaobin Wang1
  • Yuhua Yang1
  • Weikang Zhang1
  • Hao Wu1
  1. 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
  2. 2Department of Critical Care Medicine, Beijing Mentougou District Hospital, Beijing, China.
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Abstract

Adjacent segment disease (ASD) is a multifactorial long-term complication of lumbar interbody fusion. In addition to patient-related factors, pre-existing degeneration, sagittal alignment, and fusion-related changes in construct stiffness, iatrogenic disruption of the posterior elements may contribute to altered adjacent-segment biomechanics. The role of the facet joint complex in this process has received comparatively limited attention. This narrative review synthesizes biomechanical, cadaveric, and clinical evidence concerning lumbar facet arthrodesis, posterior-column preservation and reconstruction, and two-column fixation after lumbar interbody fusion. Biomechanical studies suggest that preservation of the posterior ligamentous and facet structures can influence segmental stability, load sharing, and adjacent-level intradiscal or facet stresses. Facet-based fixation provides rotational constraint under experimental conditions and may offer a different stiffness profile from conventional pedicle screw constructs. The potential role of facet arthrodesis appears to depend on the extent of posterior-element disruption, residual instability, and the stability requirements of the overall construct. Current evidence is insufficient to recommend its routine use after TLIF or PLIF or to conclude that it reduces symptomatic ASD, reoperation rates, or improves long-term patient-reported outcomes. Prospective clinical studies with long-term follow-up are required.

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Cite

BibTeXRIS
BibTeX
@article{xu2026facet,
  title = {{Facet joint fusion in lumbar surgery: a biomechanical review of posterior column preservation and reconstruction.}},
  author = {Tong Xu and Xingyu Zhao and Lei Zhang and Kai Wang and Zhenlei Liu and Shaocheng Liu and He Wang and Yaobin Wang and Yuhua Yang and Weikang Zhang and Hao Wu},
  journal = {Frontiers in surgery},
  year = {2026},
  month = oct,
  doi = {10.3389/fsurg.2026.1918664},
  url = {https://europepmc.org/article/MED/42903389},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Facet joint fusion in lumbar surgery: a biomechanical review of posterior column preservation and reconstruction.
AU  - Tong Xu
AU  - Xingyu Zhao
AU  - Lei Zhang
AU  - Kai Wang
AU  - Zhenlei Liu
AU  - Shaocheng Liu
AU  - He Wang
AU  - Yaobin Wang
AU  - Yuhua Yang
AU  - Weikang Zhang
AU  - Hao Wu
PY  - 2026
DA  - 2026/10/06
JO  - Frontiers in surgery
DO  - 10.3389/fsurg.2026.1918664
UR  - https://europepmc.org/article/MED/42903389
AB  - Adjacent segment disease (ASD) is a multifactorial long-term complication of lumbar interbody fusion. In addition to patient-related factors, pre-existing degeneration, sagittal alignment, and fusion-related changes in construct stiffness, iatrogenic disruption of the posterior elements may contribute to altered adjacent-segment biomechanics. The role of the facet joint complex in this process has received comparatively limited attention. This narrative review synthesizes biomechanical, cadaveric, and clinical evidence concerning lumbar facet arthrodesis, posterior-column preservation and reconstruction, and two-column fixation after lumbar interbody fusion. Biomechanical studies suggest that preservation of the posterior ligamentous and facet structures can influence segmental stability, load sharing, and adjacent-level intradiscal or facet stresses. Facet-based fixation provides rotational constraint under experimental conditions and may offer a different stiffness profile from conventional pedicle screw constructs. The potential role of facet arthrodesis appears to depend on the extent of posterior-element disruption, residual instability, and the stability requirements of the overall construct. Current evidence is insufficient to recommend its routine use after TLIF or PLIF or to conclude that it reduces symptomatic ASD, reoperation rates, or improves long-term patient-reported outcomes. Prospective clinical studies with long-term follow-up are required.
SN  - 2296-875X
ER  -