Abstract
BackgroundDifferent methods for lumbar pedicular screw insertion have been advocated; however, each technique has its cons and pros. Limited resources for O-arm and navigation in our locality enforced us to use our surgical skills to minimize the need for such advanced modalities.The aim of the study is to clarify the benefits of the use of free-hand technique using direct visualization of the pedicles and disc space as the only guide for pedicular screw insertion using postoperative CT for evaluation of the accuracy of pedicle screw insertion.Patients and methodsOne hundred forty-four screws were inserted in 32 patients using direct pedicle visualization and disc space orientation as a single intraoperative reference guide. The study was conducted in Zagazig University Hospitals from May, 2014, to June, 2015. CT was done for all patients as a direct postoperative evaluation tool.ResultsThere were 24 cases of single-level lumbar degenerative spondylolisthesis (96 screws) and eight with double-level degenerative spondylolisthesis DSL (48 screws). One hundred forty-four screws were inserted. Only three out of 144 screws were not purely intrapedicular; superior and lateral violations were not clinically significant.ConclusionsDirect pedicle visualization with the use of disc space orientation as a reference guide is a good alternative to the most advanced intraoperative monitoring techniques that are more readily available in developed countries.Trial registrationClinicalTrials.gov identifier: NCT03327298. Registered 30 October 2017.
Highlights
Different methods for lumbar pedicular screw insertion have been advocated; each technique has its cons and pros
Pedicle screw fixation became a cornerstone in lumbar spine instability surgery since decades
We evaluated the free-hand technique of pedicular screw insertion depending on direct visualization of the medial and inferior surfaces of the pedicle together with the nerve root and disc space orientation as the only guide without any radiological or neurophysiological aids
Summary
Different methods for lumbar pedicular screw insertion have been advocated; each technique has its cons and pros. The aim of the study is to clarify the benefits of the use of free-hand technique using direct visualization of the pedicles and disc space as the only guide for pedicular screw insertion using postoperative CT for evaluation of the accuracy of pedicle screw insertion. Others described the free-hand technique [1] depending on the anatomical identification of the pedicle entry point using the transverse process and superior articular process as the main landmarks. Austin et al [3] noted that the process of screw insertion beyond the entry point is a blind technique which usually depends on the available resources in the operating room along with the surgeon’s experience. The morphological characteristics of the pedicular lamina and roots have been described by Zindrick et al [4], Saillant et al [5], and Ebraheim et al [6]
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