The Feasibility of Long-Segment Fluoroscopy-guided Percutaneous Thoracic Spine Pedicle Screw Fixation, and the Outcome at Two-year Follow-up.

Tamburrelli Fc,Santagada Da,Perna A,Proietti L,Genitiempo M,Zirio G

doi:10.5704/moj.1911.007

Abstract

Introduction: Posterior percutaneous instrumentation may represent a challenge when multiple levels need to be instrumentated, especially when including the upper thoracic spine. The aim of the present study was to evaluate the technical feasibility and the long-term outcome of such long constructs in different surgical conditions.Materials and Methods: This investigation was a retrospective cohort study which included patients who underwent thoraco-lumbar percutaneous fixations. We collected clinical, surgical and radiological data, with a minimum follow-up of 24 months. Health-related quality-of-life, residual pain, instrumentation placement, and complications were studied.Results: A total of 18 procedures were enrolled, in which 182 screws were implanted, (170 positioned in thoracic and 12 in lumbar pedicles, respectively). No surgical complications or hardware failure occurred in our series, 6 out of 182 (3,2%) screws had a partial pedicle breach, without neurological impairment or need for surgical revision.Conclusion: According to our results, a fully posterior percutaneous approach for long thoraco-lumbar spine instrumentation can be considered safe and reproducible, although an adequate training is strictly required.

Highlights

Posterior percutaneous instrumentation may represent a challenge when multiple levels need to be instrumentated, especially when including the upper thoracic spine
Lung contusion with respiratory impairment was associated in four cases, head injury in one patient and splenic injury in one case
Two patients were affected by ankylosing spondylitis (AS), in one case the patient had an Amielic type B2 fracture and in the other case a Amielic B3 fracture[7] (Fig. 2)

Summary

Introduction

Posterior percutaneous instrumentation may represent a challenge when multiple levels need to be instrumentated, especially when including the upper thoracic spine. Conclusion: According to our results, a fully posterior percutaneous approach for long thoraco-lumbar spine instrumentation can be considered safe and reproducible, an adequate training is strictly required. Many conditions involving the TS require instrumentated surgeries, using long hardware-constructs to provide an adequate mechanical support. The risk for complications increase proportionally to the number of involved levels and prosthetic implants. Some authors reproduced their experience in lumbar minimal invasive spinal surgeries (MISS) on the TS, reporting good clinical outcomes[1,2,3,4]

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Conclusion