Facet Fusion Pioneers: Honoring the Legacy of Dr. King, Dr. Boucher, and Dr. Magerl

Dr. Kingsley R Chin MBA

Dr. Jason Seale MBA

Aditya Humad

Introduction

Posterior lumbar fixation has evolved significantly over the decades, thanks to the pioneering efforts of spine surgeons like Dr. Don King, Dr. H.H. Boucher, and Dr. Friedrich Magerl. Their innovative techniques laid the groundwork for transfacet screw fixation, a method that continues to influence spinal fusion procedures today. Building upon their foundational work, modern advancements such as the FacetFuse® transfacet pedicle screw system have emerged, offering new possibilities in spinal stabilization.

Dr. Don King (1948): The Foundational Concept

In 1948, Dr. Don King introduced the concept of internal fixation through the facet joints. His technique involved placing short screws horizontally across the facet joint, entering the inferior articular process just medial to the joint and crossing into the ipsilateral superior articular process. This method marked the first documented attempt to utilize the facet joint for internal fixation, highlighting its potential in spinal fusion.

Reference:King D. Internal fixation for lumbosacral fusion. J Bone Joint Surg Am. 1948;30:560.

Dr. H.H. Boucher (1959): Enhancing Stability

A decade later, Dr. H.H. Boucher refined King's concept by modifying the screw trajectory. He introduced longer screws inserted from the medial edge of the inferior facet with an oblique path through the facet joint, terminating in the pedicle of the vertebra below. This approach increased the screw's length and bone purchase, improving fixation strength and reducing the risk of pseudarthrosis.

Reference:Boucher HH. A method of spinal fusion. J Bone Joint Surg Br. 1959;41(2):248–259.

Dr. Friedrich Magerl (1983–1984): The Translaminar Facet Screw

Dr. Friedrich Magerl further advanced facet fixation by introducing the translaminar facet screw technique. Described in 1983–84, his method involved inserting a longer screw contralaterally from the base of the spinous process, traversing the lamina and facet joint, and terminating at the base of the transverse process. This technique increased the working length of the screw and improved construct strength, all while requiring only a midline incision with limited lateral dissection.

Reference:Magerl F. Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop Relat Res. 1984;(189):125–141.

The Modernization of Facet Fixation with FacetFuse® by Dr. Kingsley R Chin

Continuing the legacy of innovation in facet fixation, FacetFuse® was introduced in 2008 by Dr. Kingsley R. Chin, an orthopedic spine surgeon. FDA-approved that same year, FacetFuse® became a milestone in spinal fusion by incorporating the world’s first multiaxial washer integrated onto the screw head. This innovation addressed limitations of earlier techniques by enhancing intraoperative flexibility, improving load distribution, and increasing stability across the facet joint.

Dr. Chin's journey toward modernizing facet fixation began in 2004, when he performed his first transfacet pedicle screw fixation using partially threaded screws originally designed for foot fractures. At the time, he had not yet developed a dedicated system for transfacet fixation but recognized its potential as a less invasive alternative to traditional pedicle screws. After successfully developing and selling the MANTIS pedicle screw system, Dr. Chin entered into a noncompete agreement restricting him from developing pedicle screw systems. This limitation, however, became an opportunity—one that led him to look ahead and focus on the future of transfacet pedicle screws.

That vision culminated in the creation of FacetFuse®, which not only respected the principles established by King, Boucher, and Magerl but expanded upon them through modern engineering and clinical validation. With over 12,000 implants to date, the growing adoption of FacetFuse® has demonstrated its clinical viability and reinforced its place in the evolution of spinal fixation.

In a recent cadaveric biomechanical study, Dr. Chin and colleagues evaluated the performance of bilateral FacetFuse® transfacet pedicle screws (TFPS) compared to traditional pedicle screw-rod (PSR) constructs at the L5–S1 level. The study showed that bilateral TFPS provided superior immediate stability over unilateral PSR and were comparable in fixation strength to bilateral PSR. These findings suggest that FacetFuse® may reduce the need for multiple pedicle screws, offering a simpler yet equally stable construct for lumbar fusion.

At the core of FacetFuse®’s innovation is a swiveling head washer with a 12 mm beveled face, engineered to evenly distribute load across the lamina and articular process. This design not only enhances mechanical stability but also reduces complications associated with traditional PSR systems, such as nerve root irritation and rod-related challenges.

FacetFuse® is more than a device—it is the realization of a long-term vision to reimagine spinal fixation. As it builds on the legacy of King, Boucher, and Magerl, FacetFuse® represents the next generation in facet-based spinal stabilization—one shaped by history, driven by necessity, and proven in practice.

Conclusion

The evolution from King's initial facet screw fixation to Boucher's pedicle-directed trajectory, and Magerl's translaminar approach, illustrates a rich history of innovation in posterior spinal instrumentation. FacetFuse® continues this tradition, bridging historical technique with modern biomechanical insight to meet today’s surgical demands.

Incorporating devices like FacetFuse® into spinal fusion represents more than just technological progress—it is a continuation of the visionary work initiated by King, Boucher, and Magerl. By honoring their foundational contributions while striving for improved patient outcomes and surgical efficiency, FacetFuse® exemplifies how thoughtful innovation can advance the entire field of spine surgery.

References:

• King D. Internal fixation for lumbosacral fusion. J Bone Joint Surg Am. 1948;30:560.

• Boucher HH. A method of spinal fusion. J Bone Joint Surg Br. 1959;41(2):248–259.

• Magerl F. Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop Relat Res. 1984;(189):125–141.

• Chin KR, Seale JA, Bruce CA, et al. A comparative cadaveric biomechanical study of bilateral FacetFuse® transfacet pedicle screws versus bilateral or unilateral pedicle screw-rod construct. J Spine Surg. 2024;10(3):354-361. doi:10.21037/jss-24-10.