Reduction in radiation during percutaneous lumbar pedicle screw placement using a new device

Abstract

Objective: To assess a new intradermal locator device for percutaneous placement of lumbar pedicle screws. Material and methods: Patients were alternately assigned to two groups. The locator group underwent lumbar pedicle screw placement using the intradermal locator. The control group was aided by traditional fluoroscopy. Baseline demographics, visual analog scale (VAS) pain scores, operation time, intraoperative fluoroscopy time and guidewire insertion time were recorded. All postoperative CT scans were reviewed by an independent spine surgeon to grade screw placement accuracy. Results: Thirty-six patients (180 screws) were assigned to the locator group and 30 patients (128 screws) to the control group. The locator device could significantly reduce the fluoroscopy time [3.9 sec (SD = 1.9) vs. 9.6 sec (SD = 5.8), p < 0.001] and guidewire insertion time [2.69 min (SD = 0.67) vs. 4.49 min (SD = 1.96), p < 0.001] compared with the conventional method for each pedicle screw. The whole operation time of the locator group was shorter than that of the control group [2-segment: 243.2 min (SD = 16.9) vs. 301.7 min (SD = 14.9), p < 0.001; 1-segment: 154.5 min (SD = 14.3) vs. 194.6 min (SD = 19.3), p < 0.001]. As for the rates of pedicle breaches, postoperative VAS scores, no significant difference was found between the two groups. Conclusion: The intradermal locator device could help reduce the radiation exposure in percutaneous pedicle screw placement while maintaining the accuracy.