Percutaneous Pedicle Screw Fixation Group Research Articles

A Comparison of Outcomes between the Wiltse Approach with Pedicle Screw Fixation and the Percutaneous Pedicle Screw Fixation for Multi-Segmental Thoracolumbar Fractures.

Multi-segmental thoracolumbar fracture (MSF) generally refers to fractures occurring in two or more segments of the thoracolumbar spine. With the development of minimally invasive concept, there is little research on its application in the field of MSF. The purpose of this study is to compare two minimally invasive surgical techniques and determine which one is more suitable for treating patients with neurologically intact MSF. We retrospectively analyzed the clinical data of 49 MSF patients with intact nerves who were admitted from January 2017 to February 2019. Among them, 25 cases underwent percutaneous pedicle screw fixation (PPSF), and 24 cases underwent Wiltse approach pedicle screw fixation (WAPSF). The operation time, number of fixed segments, blood loss, length of incision, postoperative ambulation time, accuracy of pedicle screw placement, facet joint violation (FJV), number of C-arm exposures, as well as pre- and postoperative visual analogue scale (VAS), Oswestry disability index (ODI), local Cobb's angle (LCA), and percentage of anterior vertebral body height (PAVBH) were recorded for both groups. Paired sample t-test was used for intra-group comparison before and after surgery while independent sample t-test was used for inter-group comparison. The differences in the number of fixed segments, intraoperative bleeding, postoperative bed time, accuracy rate of pedicle screw placement, VAS, and ODI between the two groups were not statistically significant (p > 0.05). However, the operative time and total surgical incision length were significantly shorter in the WAPSF group than in the PPSF group (p < 0.05), and the FJV was significantly higher in the PPSF group than in the WAPSF group (p < 0.05). Also, the PPSF group received more intraoperative fluoroscopy (p < 0.05). The result of LCA and PAVBH in the WAPSF group were significantly better than in the PPSF group (p < 0.05). Both PPSF and WAPSF were found to be safe and effective in the treatment of MSF without neurological deficits through our study. However, considering radiation exposure, FJV, vertebral height restoration, correction of kyphosis, and learning curve, WAPSF may be a better choice for neurologically intact MSF.

Hidden blood loss between percutaneous pedicle screw fixation and the mini-open Wiltse approach with pedicle screw fixation for neurologically intact thoracolumbar fractures: a retrospective study

BackgroundThe aim of this study was to determine the proportion of hidden blood loss (HBL) in patients treated with minimally invasive surgery, and to compare the HBL between patients treated with percutaneous pedicle screw fixation (PPSF) and the mini-open Wiltse approach with pedicle screw fixation (MWPSF).MethodsFrom January 2017 to January 2019, a total of 119 patients with thoracolumbar fractures were included in the analysis, of which 58 cases received PPSF and 61 cases received MWPSF. The clinical information and demographic results were collected and compared. And the HBL of the patients is calculated by the combination formulas of Nadler, Gross and Sehat.ResultsCompared with the PPSF group, operation time of MWPSF is shorter. The fluoroscopy times are 13.6 ± 3.0 in PPSF group and 5.6 ± 1.6 in MWPSF group (p < 0.001). As shown in Table 3, the intraoperative blood loss in PPSF group is 31.9 ± 9.6 ml, which is significantly less than that in the MWPSF group (44.0 ± 14.9 ml). The HBL (445.7 ± 228.9 ml), and HBL% (91.2 ± 7.7%) of the PPSF group are significantly higher than that in the MWPSF group (P < 0.05). And the total blood loss (TBL) of the PPSF group (477.6 ± 228.8 ml) is also more than that in the MWPSF group (401.0 ± 171.3 ml).ConclusionsOur results suggest that in the minimally invasive surgical treatment of thoracolumbar fractures, the perioperative HBL is much higher than visible blood loss (VBL). Although PPSF has less intraoperative blood loss, it has higher TBL and HBL than those of MWPSF. Compared with MWPSF, we should pay more attention to the postoperative anemia status of patients with thoracolumbar fractures undergoing PPSF surgery.

Oblique lateral interbody fusion stand-alone vs. combined with percutaneous pedicle screw fixation in the treatment of discogenic low back pain.

ObjectiveOblique lateral interbody fusion (OLIF) has unique advantages in the treatment of discogenic low back pain (DBP). However, there are few studies in this area, and no established standard for additional posterior internal fixation. The purpose of this study was to investigate the efficacy of OLIF stand-alone vs. combined with percutaneous pedicle screw fixation (PPSF) in the treatment of DBP.MethodsThis retrospective case-control study included forty patients. All patients were diagnosed with DBP by discography and discoblock. Perioperative parameters (surgery duration, blood loss, and muscle damage), complications, Visual analog scale (VAS), and Oswestry Disability Index (ODI) were assessed. Imaging data including cage subsidence, cage retropulsion, fusion rate, and adjacent spondylosis degeneration (ASD) were analyzed.ResultsThere were 23 patients in the OLIF stand-alone group and 17 patients in the OLIF + PPSF group. The mean surgery duration, blood loss, and muscle damage in the OLIF stand-alone group were significantly better than those in the OLIF + PPSF group (P < 0.05). However, there was no significant difference in the average hospitalization time between the two groups (P > 0.05). There was no significant difference in the VAS and ODI scores between the two groups before surgery (P > 0.05), and VAS and ODI scores significantly improved after surgery (P < 0.05). The VAS and ODI scores in the OLIF stand-alone group were significantly better than those in the OLIF + PPSF group at 1 month (P < 0.05), While there was no significant difference between the two groups at 12 months and last follow up (P > 0.05). At the last follow-up, there was no significant difference in cage subsidence, fusion rate, ASD and complication rate between the two groups (P > 0.05).ConclusionOLIF stand-alone and OLIF + PPSF are both safe and effective in the treatment of DBP, and there is no significant difference in the long-term clinical and radiological outcomes. OLIF stand-alone has the advantages of surgery duration, blood loss, muscle damage, and early clinical effect. More clinical data are needed to confirm the effect of OLIF stand-alone on cage subsidence and ASD. This study provides a basis for the clinical application of standard DBP treatment with OLIF.

Short Segment Pedicle Screw Fixation for Thoracolumbar Burst Fractures. Percutaneous without Fusion Versus Open Pedicle Screw Fixation with Posterolateral Fusion

Background: Fixation of thoracolumbar burst fractures (TLBF) with short segment pedicle screw construct has become popular over last few decades. Spine surgeons have started to deal advanced degenerative spinal pathologies with percutaneous pedicle screw fixation (PPSF) as well. Short segment PPSF has been demonstrated to be an effective treatment option for TLBF fixation in fewer studies so far. This study compared the short segment open pedicle screw fixation (OPSF) with fusion to a short segment PPSF without fusion in the management of TLBF. Methods: Between December 2019 and October 2021, fifty nine patients underwent short-segment pedicle screw fixation, 32 PPSF while 27 OPSF for TLBF. Each of the three follow-up examinations included radiographs to ensure that the spinal column had recovered to its pre-injury state. A lateral thoracolumbar radiograph was used to calculate the Cobb angle, vertebral wedge angle, and vertebral body compression ratio. In this study, patients' pain and function were assessed using the VAS, the Frankel grading system, and the Low Back Outcome Score (LBOS). Additionally, the volume of blood loss and the time required to finish the procedure were also noted. Results: Regional Cobb angle improved post operatively in both groups without any disparity when assessed the two groups, which was noticed till three months. Operative time and blood loss was less in PPSF. LBOS and VAS markedly improved during early follow ups in PPSF group compare to OPSF. Concluding follow up did not show significant difference between PPSF and OPSF. Conclusions: Open or percutaneous short-segment pedicle fixation with or without fusion is secure and efficient treatment option for TLBF. PPSF alone resulted in a greater reduction in pain and improvement in functional ability than the OPSF during initial time period which substantially improve overall outcome in management of TLBF.

Minimal invasive fixation following with radiotherapy for radiosensitive unstable metastatic spine

BackgroundMinimally invasive surgery (MIS) has become a feasible option for patients with spinal metastasis, but the effectiveness of percutaneous pedicle screw fixation (PPSF) without decompression in patients with severe cord compression remains unknown. We compared PPSF without decompression with debulking surgery in patients with radiosensitive, unstable, metastatic thoracolumbar spinal cord compression. MethodsA retrospective study of surgically treated spinal metastasis and spinal cord compression patients was conducted between October 2014 and June 2019. Demographic and pre- and postoperative data were collected and compared between patients treated with minimally invasive percutaneous fixation and external beam radiotherapy (EBRT) (the PPSF group) and those treated with debulking surgery (the debulking group). ResultsWe included 50 patients in this study. The PPSF group had a significantly shorter operative time (143.56 ± 49.44 min vs. 181.47 ± 40.77 min; p < 0.01), significantly lower blood loss (116.67 ± 109.92 mL vs. 696.55 ± 519.43 mL; p < 0.01), and significantly shorter hospital stay (11.90 ± 9.69 vs. 25.35 ± 20.65; p < 0.01) than did the debulking group. No significant differences were observed between the groups in age, sex, spinal instability neoplastic score, ESCC, Tomita scores, numeric rating scale scores, American Spinal Injury Association Impairment Scale scores, survival rates, and complication rates. Postoperative neurologic function and decrease in pain were similar between the groups. ConclusionThe PPSF group had a shorter operation time, shorter length of hospital stay, and less blood loss than did the debulking group. PPSF followed by EBRT is pain relieving, relatively safe and appropriate as palliative therapy.

Comparison of outcome between percutaneous pedicle screw fixation and the Mini-Open Wiltse Approach with pedicle screw fixation for neurologically intact thoracolumbar fractures: A retrospective study

BackgroundThe purpose of this study was to compare the outcome between percutaneous pedicle screw fixation (PPSF) and the mini-open Wiltse approach with pedicle screw fixation (MWPSF) for neurologically intact thoracolumbar fractures. MethodsFrom January 2017 to January 2019, ninety-four patients with neurologically intact thoracolumbar fractures were included in this study. In this retrospective study, forty-nine patients were operated with the PPSF and forty-five patients received MWPSF. The clinical information, surgery-related results and radiographic outcome were collected and compared between the two groups. ResultsThere was no significant difference between the two groups in total length of incisions, blood loss, post-operative hospitalization time, visual analog scale (VAS) score and Oswestry disability index (ODI) score. There was also no significant difference in the accuracy rate of pedicle screw placement between two groups; however, the facet joint violation (FJV) was significantly higher in the PPSF group. The atrophic area of multifidus muscle in the PPSF group is significantly larger than that in the MWPSF group and the operative time of MWPSF group was shorter than that in the PPSF group. Meanwhile, the PPSF group obtaining significantly more cumulative exposure to radiation (p < 0.001). The result of vertebral body angle (VBA), Cobb's angle and AVH rate in the MWPSF group were significantly better than those in the PPSF group at the last post-operative follow-up. ConclusionsBoth minimally invasive treatment techniques (PPSF and MWPSF) are safe and effective in treatment of neurologically intact thoracolumbar fractures. Nevertheless, our results indicate that MWPSF may be a better choice for neurologically intact thoracolumbar fractures, since it protects multifidus muscle, and decreases facet joint violation, operation time, as well as radiation exposure. In addition, MWPSF was associated with better reduction of kyphosis.

A comparison of three different surgery approaches and methods for neurologically intact thoracolumbar fractures: a retrospective study

ObjectivesThe purpose of this study was to evaluate and compare the feasibility, safety, and efficacy of conventional open pedicle screw fixation (COPSF), percutaneous pedicle screw fixation (PPSF), and paraspinal posterior open approach pedicle screw fixation (POPSF) for treating neurologically intact thoracolumbar fractures.MethodsWe retrospectively reviewed 108 patients who were posteriorly stabilized without graft fusion. Among them, 36 patients underwent COPSF, 38 patients underwent PPSF, and 34 patients underwent POPSF. The clinical outcomes, relative operation indexes, and radiological findings were assessed and compared among the 3 groups.ResultsAll of the patients were followed up for a mean time of 20 months. The PPSF group and POPSF group had shorter operation times, lower amounts of intraoperative blood loss, and shorter postoperative hospital stays than the COPSF group (P < 0.05). The radiation times and hospitalization costs were highest in the PPSF group (P < 0.05). Every group exhibited significant improvements in the Cobb angle (CA) and the vertebral body angle (VBA) correction (all P < 0.05). The COPSF group and the POPSF group had better improvements than the PPSF group at 3 days postoperation and the POPSF group had the best improvements in the last follow-up (P < 0.05).ConclusionBoth PPSF and POPSF achieved similar effects as COPSF while also resulting in lower incidences of injury. PPSF is more advantageous in the early rehabilitation time period, compared with COPSF, but POPSF is a better option when considering the long-term effects, the costs of treatment, and the radiation times.

Analysis of outcome of percutaneous versus open pedicle screw fixation in the treatment of thoraco-lumbar spine fractures: a prospective comparative study

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Aim of the study was to evaluate the effectiveness between percutaneous and open pedicle screw fixation in the treatment of traumatic thoracolumbar burst fractures with spinal injury.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective comparative study including thirty patients with thoracolumbar burst fracture were equally divided into an open pedicle screw fixation (OPSF) group and a percutaneous pedicle screw fixation (PPSF) group. Demographic characteristics, clinical and radiological outcomes, and adverse events were assessed and compared between the 2 groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Demographic and clinical features including age, gender, fracture level, mechanism of injury and neurological status in both groups were not significantly different (all p&amp;gt;0.05). The PPSF group exhibits significantly lower operative time, intraoperative blood loss, and hospital stay compared with the OPSF group (all p&amp;lt;0.05). There was no significant difference in the sagittal Cobb′s angle (CA), fracture vertebral body angle (VBA), anterior vertebral body height (AVBH) on pre-operative, immediate post-operative and final follow up between the two surgical techniques (all p&amp;gt;0.05). Visual analogue scale (VAS) remarkably decreased in both groups after surgery but difference was not statically significant (p=0.808). Common postoperative complications in both groups were superficial infections, pressure ulcer and urinary tract infection (UTI) worsening. Hardware failure was seen only in one case of PPSF group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Patients with thoracolumbar burst fractures can be effectively managed with PPSF/OPSF. There were no significant differences in radiological and clinical outcomes and post-op complications between 2 groups but blood loss, operative time and hospitalization stay were less in percutaneous group, which may represent a potential benefit.&lt;/p&gt;&lt;p&gt;&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;

Pedicle Screw Fixation with Percutaneous Vertebroplasty for Traumatic Thoracolumbar Vertebral Compression Fracture.

This study aims to evaluate the clinical efficacy of percutaneous pedicle screw fixation (PPSF) combined with percutaneous vertebroplasty (PVP) for the treatment of the thoracolumbar vertebral compression fracture (VCF) without neurologic deficits. This was a prospective observational study. Between January 2015 and December 2018, 62 patients who had suffered from traumatic thoracolumbar (VCF) burst fractures without neurologic deficits were included in this study. The patients were divided into two groups as follows: patients who underwent PPSF combined with PVP (PPSF-PVP Group; n = 24) and patients who underwent only PPSF (PPSF Group; n = 38). The patients were (PPSF and PPSF-PVP Group) followed up for more than 9 months. The kyphotic angle, compression ratio, and visual analog scale (VAS) score for back pain were analyzed and compared between the two groups. The patients were followed up for an average of 9.1 months. Hospital stay significantly decreased in PPSF-PVP Group (P < 0.001). The median VAS score significantly decreased after the surgery in both the groups (P < 0.005), and mean VAS scores in PPSF-PVP Group were significantly lower than those in PPSF Group. No significant (P > 0.005) changes in local kyphosis and the vertebral body height gains obtained at the end of the follow-up period in PPSF-PVP Group. However, local kyphosis increased significantly (P < 0.005) and the central and anterior vertebral body height decreased significantly (P < 0.005) when compared with the PPSF-PVP Group. PPSF combined with PVP procedure is a good choice for the treatment of traumatic thoracolumbar VCF; however, due to the lack of long-term follow-up data, concern still exists regarding the effects of pedicle screw procedure after PVP.

Clinical profile of thoracolumbar spine fracture in adult

Most common site of injury was L1 vertebra. There was an increase in incidence of spinal cord injuries during summer and rainy season. All those cases of unstable dorsolumbar fractures were included in the study that fulfilled following criteria. In our series, most common type was wedge compression fractures, accounting for 56% of the cases. Next common type is burst fracture 44%.In percutaneous pedicle screw fixation group, wedge compression fracture 64% were operated, compared to 48% of conventional pedicle fixation group. Burst fractures, which constituted 36% was the in percutaneous pedicle fixation group compared to 52% of conventional pedicle fixation group. Most common type was wedge compression fracture

Unilateral versus bilateral percutaneous pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion

Clinical results for unilateral pedicle screw fixation after lumbar interbody fusion have been reported to be as good as those for bilateral instrumentation. However, no studies have directly compared unilateral and bilateral percutaneous pedicle screw fixation after minimally invasive surgery (MIS) for transforaminal lumbar interbody fusion (TLIF). The purpose of this study was to determine whether unilateral percutaneous pedicle screw fixation is comparable with bilateral percutaneous pedicle screw fixation in 1-segment MIS TLIF. This was a prospective randomized study of 53 patients who underwent unilateral or bilateral percutaneous pedicle screw fixation after MIS TLIF for 1-segment lumbar degenerative disc disease. Twenty-six patients were assigned to a unilateral percutaneous pedicle screw fixation group and 27 patients were assigned to a bilateral percutaneous pedicle screw fixation group. Operative time, blood loss, clinical outcomes (that is, Oswestry Disability Index [ODI] and visual analog scale [VAS] scores), complication rates, and fusion rates were assessed using CT scanning 2 years after surgical treatment. The 2 groups were similar in age, sex, preoperative diagnosis, and operated level, and they did not differ significantly in the length of follow-up (27.5 [Group 1] vs 28.9 [Group 2] months) or clinical results. Both groups showed substantial improvements in VAS and ODI scores 2 years after surgical treatment. The groups differed significantly in operative time (unilateral 84.2 minutes; bilateral 137.6 minutes), blood loss (unilateral 92.7 ml; bilateral, 232.0 ml), fusion rate (unilateral 84.6%; bilateral 96.3%), and postoperative scoliotic change (unilateral 23.1%; bilateral 3.7%). Unilateral and bilateral screw fixation after MIS TLIF produced similar clinical results. Although perioperative results were better with unilateral screw fixation, the long-term results were better with bilateral screw fixation, suggesting bilateral screw fixation is a better choice after MIS TLIF.

Comparison between the accuracy of percutaneous and open pedicle screw fixations in lumbosacral fusion

Background contextIn pedicle screw fixation, accurate insertion is essential to avoid neurological injury or weak stability. The percutaneous pedicle screw system was developed for minimally invasive spine surgery, and its safety has already been reported. However, the accuracy of percutaneous pedicle screw fixation (PPF) has not been compared with that of the open system to date. PurposeTo compare the accuracy of PPF with that of open pedicle screw fixation (open PF) and to investigate the risk factors associated with pedicle wall penetration. Study design/settingA retrospective case series. Patient sampleThe study group included 237 patients who underwent posterior pedicle screw fixation between January 2008 and October 2010 at a single institute with a total of 1,056 pedicle screw fixations completed. One hundred and twenty-six patients with 558 screws underwent open PF and 111 patients with 498 screws underwent PPF. Outcome measuresPostoperative computerized tomography, including sagittal and coronal reformatted images. MethodsConsecutive surgeries with either conventional open PF or PPF for anterior lumbar interbody fusion or transforaminal lumbar interbody fusion were performed. The open pedicle screw employed was from the WSH system (Winova, Seoul, Korea), and the two percutaneous pedicle screw systems were the Sextant (Medtronics, Minneapolis, MN, USA) and the Viper systems (DePuy Spine, Raynham, MA, USA). Computed tomography images were evaluated to determine pedicle wall penetration after operation. Severity was classified as mild (<3 mm), moderate (3–6 mm), and severe (≥6 mm), and the direction was assessed as medial, lateral, inferior, and superior. ResultsPedicle wall penetration occurred in 75 patients (13.4%) in the open PF group and 71 patients (14.3%) in the PPF group and was not statistically different between the groups (p=.695). Assessment of the severity of the pedicle wall penetration revealed that minor penetration was the most common (open PF group, 9.7%; PPF group, 10.6%), although the distribution of the degree of severity was not statistically different between the groups (p=.863). A relatively higher incidence of lateral penetration was observed in the open PF group (66.7% vs. 43.7%), whereas medial, superior, and inferior penetrations were higher in the PPF group (p=.033). Other parameters such as age, sex, surgical method, and surgeon factors did not influence the penetration rate, but bone mineral densitometry negatively correlated with the penetration. ConclusionsPedicle wall penetration during screw fixation was not different between the open PF and PPF groups. The lateral, paraspinal, muscle-splitting approach seems to lessen medial wall penetration, especially in the S1 vertebra. Distribution of the direction of penetration differs between the groups, with lateral wall penetration being more prominent in the open PF group. Careful placement of pedicle screws is necessary for a stronger construct because of the high incidence of penetration.

Comparison of instrumented posterolateral fusion versus percutaneous pedicle screw fixation combined with anterior lumbar interbody fusion in elderly patients with L5–S1 isthmic spondylolisthesis and foraminal stenosis

The purpose of this study was to compare the clinical and radiological outcomes of treating L5-S1 isthmic spondylolisthesis and foraminal stenosis in elderly patients with instrumented posterolateral fusion (PLF) versus percutaneous pedicle screw fixation (PSF) combined with anterior lumbar interbody fusion (ALIF). Forty-nine patients older than 65 years of age with L5-S1 isthmic spondylolisthesis and symptomatic foraminal stenosis who underwent ALIF were retrospectively analyzed. An ALIF with instrumented PLF (Group A) was performed in 23 patients, and ALIF with percutaneous PSF (Group B) was performed in 26 patients. Data were collected preoperatively and at 3 months, 6 months, 1 year, and every subsequent year. A comparative analysis was made between the 2 groups using clinical (visual analog pain scale [VAS] and modified MacNab criteria) and radiological (dynamic plain radiographs and CT scans) measures. The mean follow-up duration was 30.3 months (range 24-47 months). The mean preoperative scores on the VAS for low-back pain in Groups A and B were 5.9 and 5.7, respectively, decreasing to 1.4 and 3.6, respectively, at 6 months after surgery (p = 0.001), whereas VAS scores for low-back pain in Groups A and B at 2 years postoperatively were 1.3 and 2.3, respectively (p = 0.005). The mean preoperative scores on the VAS for leg pain in Groups A and B were 7.5 and 7.8, respectively, decreasing at 6 months after surgery to 1.2 and 1.6, respectively (p = 0.201), whereas VAS scores for leg pain in Groups A and B at 2 years postoperatively were 1.3 and 1.4, respectively (p = 0.803). The rates of patients with excellent or good outcomes in terms of the modified MacNab criteria in Groups A and B were 91.3% and 69.2%, respectively, at 6 months after surgery (p = 0.010). Those rates in Groups A and B at 2 years after the operation were 91.3% and 84.6%, respectively (p = 0.203). The fusion rates in Groups A and B were 91.3% and 57.7%, respectively, at 6 months after surgery (p = 0.008), whereas the fusion rates in Groups A and B were 91.3% and 76.9%, respectively, at 2 years after surgery (p = 0.103). There was no significant difference in terms of the complication rate between Group A (4.3%) and B (3.8%) (p = 0.691). A relatively longer time until, and lower rate for, fusion in the patients treated with ALIF and percutaneous PSF were noted, which may be correlated with a relatively lower rate of patients with excellent or good outcomes. These results seem to favor ALIF with instrumented PLF rather than ALIF with percutaneous PSF in the treatment of elderly patients with L5-S1 isthmic spondylolisthesis and foraminal stenosis. However, additional long-term follow-up, a larger number of patients, and well-designed studies are necessary for a more rigorous evaluation of the outcome of patients treated using these surgical techniques.