Percutaneous Pedicle Screw Fixation Research Articles

Short-Term Comparison Between Unilateral Versus Bilateral Percutaneous Pedicle Screw Fixation in Short-Level Lateral Lumbar Interbody Fusion-A Prospective Randomized Study.

Prospective randomized controlled trial. No prospective studies have directly compared clinical and radiographic outcomes of unilateral vs bilateral instrumented lateral lumbar interbody fusion (LLIF) for lumbar degenerative disease (LDD). We compared the short-term radiographic, clinical outcomes, and some complications of the unilateral percutaneous pedicle screw (PPS) (UPS) vs bilateral PPS (BPS) fixation in short-level spinal fusion with LLIF for LDD. This was a prospective randomized controlled study of 33 patients who underwent UPS or BPS fixation after LLIF for LDD; 18 patients were assigned to the UPS group and 15 patients to the BPS group. Clinical outcomes, complication rates, and fusion rates were assessed. The two groups were similar in age, sex, preoperative diagnosis, and level of surgery. Blood loss, length of hospital stay, and numeric rating scale score one year after surgery did not differ between groups. The operative time was longer in the BPS than UPS group (120.2 vs 88.8min, respectively; P = .029). Both groups showed improvement in disc height and dural sac in the immediate postoperative computed tomography and magnetic resonance imaging, which did not differ significantly between groups. The subsidence grade and fusion rate did not differ, but cage subsidence was more severe in the UPS than BPS group. Unilateral and bilateral PPS fixation after LLIF yielded similar short-term clinical and radiological outcomes. However, severe cage subsidence was more common in the UPS group, which suggests that BPS fixation after LLIF may be a better choice over the long term.

Outcome of percutaneous pedicle screw fixation for traumatic thoracic and lumbar fractures –six years experience

Objectives This study discusses the experience at our centre with treating traumatic thoracolumbar fractures using percutaneous pedicle screw fixation. Methods We reviewed the case notes and imaging retrospectively between January 2013 and June 2019. Results A total of 257 patients were included, 123 males and 134 females aged between 17 and 70; the mean age was 47.6 years. The majority of injuries were from fall from significant height. The fractures involved the thoracic and lumbar vertebra in 98 and 151 of the cases respectively. Percutaneous pedicle screw fixation was performed either one or two levels above and below the fracture depending on the level of injury. Forty two cases were treated with additional short pedicle screws at the level of fracture. More than 15% (39) of the patients presented with a neurological deficit; more than 80% (32) of those showed post-operative improvement in their neurology as per Frankel Grading system. The mean operative time was 117 min ± 45 min; mean length of hospital stay was 7.2 days ± 3.8 days, with significant improvement in pain. Conclusions Percutaneous pedicle screw fixation is a safe surgical option with comparable outcomes to open surgery and a potential reduction in perioperative morbidity.

Technique for Validation of Intraoperative Navigation in Minimally Invasive Spine Surgery.

Intraoperative 3-dimensional navigation is an enabling technology that has quickly become a commonplace in minimally invasive spine surgery (MISS). It provides a useful adjunct for percutaneous pedicle screw fixation. Although navigation is associated with many benefits, including improvement in overall screw accuracy, navigation errors can lead to misplaced instrumentation and potential complications or revision surgery. It is difficult to confirm navigation accuracy without a distant reference point. To describe a simple technique for validating navigation accuracy in the operating room during MISS. The operating room is set up in a standard fashion for MISS with intraoperative cross-sectional imaging available. A 16-gauge needle is placed within the bone of the spinous process before intraoperative cross-sectional imaging. The entry level is chosen such that the space between the reference array and the needle encompasses the surgical construct. Before placing each pedicle screw, accuracy is verified by placing the navigation probe over the needle. This technique has identified navigation inaccuracy and led to repeat cross-sectional imaging. No screws have been misplaced in the senior author's cases since adopting this technique, and there have been no complications attributable to the technique. Navigation inaccuracy is an inherent risk in MISS, but the described technique may mitigate this risk by providing a stable reference point.

Surgical outcome of minimal invasive oblique lateral interbody fusion with percutaneous pedicle screw fixation in the treatment of adult degenerative scoliosis

Oblique lateral interbody fusion is performed for lumbar spinal restoration and stabilization, without extensive paraspinal muscle damage or massive bleeding. This study aimed to confirm the radiological and clinical outcomes of minimally invasive oblique lateral interbody fusion (OLIF) with percutaneous pedicle screw fixation (PPSF) as treatment for adult degenerative lumbar scoliosis. Medical records of 40 patients with degenerative lumbar spinal deformities who underwent selective OLIF and PPSF at our hospital between April 2018 and February 2021 were retrospectively reviewed. The study population comprised 7 male and 33 female patients aged 55-79 years. Standing radiography was performed, and the coronal cobb angle, distance between the C7 plumb line and central sacral vertical line, sagittal vertical axis, pelvic tilt, lumbar lordosis (LL), pelvic incidence (PI), and difference between PI and LL (PI-LL) were measured. Coronal scoliosis was defined as a lumbar coronal plane curve of > 15°. All patients achieved statistically significant improvements in coronal and sagittal alignment. The coronal cobb angle was corrected from 18.82° to 11.52°, and the central sacral vertical line was reduced from 18.30 mm to 15.47 mm. The sagittal vertical axis was significantly reduced from 45.95 mm to 32.72 mm. In contrast, the pelvic tilt and LL were minimally changed. For subgroup analyses, patients were divided into the convex and concave groups according to the direction of coronal curve correction. Vertebral body rotation was superior in the convex group than in the concave group. Furthermore, we checked for asymmetric facet degeneration at the upper instrumented vertebra (UIV) level at 1 year postoperatively. Of the 22 patients who underwent more than 3 level fusion surgery, 8 patients were confirmed the postoperative asymmetric facet degeneration in above UIV. Minor complications occurred in 16 patients, who recovered without any problems. Revision surgery was not performed in all cases. Minimally invasive OLIF with PPSF has a lower risk of complications and favorable surgical outcomes in patients with adult degenerative lumbar scoliosis. Access from the convex side is advantageous for the correction of the rotated vertebra. Extending the UIV level to the neutral vertebra can reduce the occurrence of postoperative asymmetric facet degeneration.

Radiographic and MRI evidence of indirect neural decompression after the anterior column realignment procedure for adult spinal deformity.

The anterior column realignment (ACR) procedure, which consists of sectioning the anterior longitudinal ligament/annulus and placing a hyperlordotic interbody cage, has emerged as a minimally invasive surgery (MIS) for achieving aggressive segmental lordosis enhancement to address adult spinal deformity (ASD). Although accumulated evidence has revealed indirect neural decompression after lateral lumbar interbody fusion (LLIF), whether ACR serves equally well for neural decompression remains to be proven. The current study intended to clarify this ambiguous issue. A series of 36 ASD patients with spinopelvic mismatch, defined as pelvic incidence (PI) minus lumbar lordosis (LL) > 10°, underwent a combination of ACR, LLIF, and percutaneous pedicle screw (PPS) fixation. This "MIS triad" procedure was applied over short segments with mean fusion length of 3.3 levels, and most patients underwent single-level ACR. The authors analyzed full-length standing radiographs, CT and MRI scans, and Oswestry Disability Index (ODI) scores in patients with minimum 1 year of follow-up (mean [range] 20.3 [12-39] months). Compared with the preoperative values, the radiographic and MRI measurements of the latest postoperative studies changed as follows. Segmental disc angle more than quadrupled at the ACR level and LL nearly doubled. MRI examinations at the ACR level revealed a significant (p < 0.0001) increase in the area of the dural sac that was accompanied by significant (p < 0.0001) decreases in area and thickness of the ligamentum flavum and in thickness of the disc bulge. The corresponding CT scans demonstrated significant (all p < 0.0001) increases in disc height to 280% of the preoperative value at the anterior edge, 224% at the middle edge, and 209% at the posterior edge, as well as in pedicle-to-pedicle distance to 122%. Mean ODI significantly (p < 0.0001) decreased from 46.3 to 26.0. The CT-based data showing vertebral column lengthening across the entire ACR segment with an increasingly greater degree anteriorly suggest that the corrective action of ACR relies on a lever mechanism, with the intact facet joints acting as the fulcrum. Whole-segment spine lengthening at the ACR level reduced the disc bulge anteriorly and the ligamentum flavum posteriorly, with eventual enlargement of the dural sac. ACR plays an important role in not only LL restoration but also stenotic spinal canal enlargement for ASD surgery.

Size selection and placement of pedicle screws using robot-assisted versus fluoroscopy-guided techniques for thoracolumbar fractures: possible implications for the screw loosening rate

BackgroundThere has been increased development of robotic technologies for the accuracy of percutaneous pedicle screw placement. However, it remains unclear whether the robot really optimize the selection of screw sizes and enhance screw stability. The purpose of this study is to compare the sizes (diameter and length), placement accuracy and the loosening rate of pedicle screws using robotic-assisted versus conventional fluoroscopy approaches for thoracolumbar fractures.MethodsA retrospective cohort study was conducted to evaluate 70 consecutive patients [34 cases of robot-assisted percutaneous pedicle screw fixation (RAF) and 36 of conventional fluoroscopy-guided percutaneous pedicle screw fixation (FGF)]. Demographics, clinical characteristics, and radiological features were recorded. Pedicle screw length, diameter, and pedicle screw placement accuracy were assessed. The patients’ sagittal kyphosis Cobb angles (KCA), anterior vertebral height ratios (VHA), and screw loosening rate were evaluated by radiographic data 1 year after surgery.ResultsThere was no significant difference in the mean computed tomography (CT) Hounsfield unit (HU) values, operation duration, or length of hospital stay between the groups. Compared with the FGF group, the RAF group had a lower fluoroscopy frequency [14 (12–18) vs. 21 (16–25), P < 0.001] and a higher “grade A + B” pedicle screw placement rate (96.5% vs. 89.4%, P < 0.05). The mean screw diameter was 6.04 ± 0.55 mm in the RAF group and 5.78 ± 0.50 mm in the FGF group (P < 0.001). The mean screw length was 50.45 ± 4.37 mm in the RAF group and 48.63 ± 3.86 mm in the FGF group (P < 0.001). The correction loss of the KCA and VHR of the RAF group was less than that of the FGT group at the 1-year follow-up [(3.8 ± 1.8° vs. 4.9 ± 4.2°) and (5.5 ± 4.9% vs. 6.4 ± 5.7%)], and screw loosening occurred in 2 out of 34 patients (5.9%) in the RAF group, and 6 out of 36 patients (16.7%) in the FGF group, but there were no significant differences (P > 0.05).ConclusionCompared with the fluoroscopy-guided technique, robotic-assisted spine surgery decreased radiation exposure and optimizes screw trajectories and dimensions intraoperatively. Although not statistically significant, the loosening rate of the RAF group was lower that of than the FGT group.

Instrumentation choice and early radiographic outcome following lateral lumbar interbody fusion (LLIF): Lateral instrumentation versus posterior pedicle screw fixation

BackgroundLateral lumbar interbody fusion (LLIF) is a minimally invasive fusion procedure that may be performed with or without supplemental instrumentation. However, there is a paucity of evidence on the effect of supplemental instrumentation technique on perioperative morbidity and fusion rate in LLIF. MethodsA single-institutional retrospective review of patients who underwent LLIF for lumbar spondylosis was conducted. Patients were grouped according to supplemental instrumentation technique: stand-alone LLIF, LLIF with laterally placed instrumentation, or LLIF with posterior percutaneous pedicle screw fixation (PPSF). Outcomes included fusion rates, peri-operative complication, and reoperation; estimated blood loss (EBL); surgery duration; length of stay; and length of follow-up. Results82 patients underwent LLIF at 114 levels. 35 patients (42.7%) received supplemental lateral instrumentation, 30 (36.6%) received supplemental PPSF, and 17 (20.7%) underwent stand-alone LLIF. More patients in the lateral instrumentation group had prior lumbar fusion at adjacent levels (23/35, 65.71%) versus stand-alone (3/17, 17.6%) or PPSF (2/30, 6.67%) groups (p = 0.003). 4/17 patients (23.5%) with stand-alone LLIF and 4/35 patients (11.42%) with lateral instrumentation underwent reoperation, versus 0/30 with PPSF (p = 0.030). There was no difference in fusion rates between groups (p = 0.717). Operation duration was longer in patients with PPSF (p < 0.005) and length of follow-up was longer for PPSF than lateral instrumentation (p = 0.001). Choice of instrumentation group was a statistically significant predictor of reoperation. ConclusionsWhile rates of complete radiographic fusion on imaging follow-up didn't differ, patients receiving PPSF were less likely than stand-alone or lateral instrumentation groups to require reoperation, though operative time was significantly longer. Further study of choice of supplemental instrumentation with LLIF is indicated.

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.

Therapeutic effect of percutaneous pedicle screw fixatio n, combined with Tongdu Huoxue decoction on thoracolumbar spine fracture

Purpose: To study the therapeutic effect of percutaneous pedicle screw fixation (PPSF) combined with Tongdu Huoxue decoction on thoracolumbar spine fractures.&#x0D; Methods: Ninety-eight patients with thoracolumbar spine fractures treated with PPSF were retrospectively enrolled and grouped into a study group (SG, n = 51, PPSF combined with THD), and a control group (CG, n = 47, PPSF). General surgical indices, postoperative pain, postoperative Oswestry dysfunction index (ODI index), preoperative and postoperative imaging indices, and postoperative hemodynamic indices were determined and recorded.&#x0D; Results: Patients in SG exhibited significantly lower visual analog scale (VAS) scores higher than those of CG at 3, 7 and 15 days after surgery (p &lt; 0.05). At 15 and 30 days after surgery, patients in SG exhibited significantly lower ODI index than those in CG (p &lt; 0.05). At day 60 after surgery, Cobb angle was lower in SG than in CG, while the injured vertebral body showed higher anterior height in SG than in CG. Furthermore, FIB and D-D were lower in SG than in CG at day 7, but exhibited higher PT than CG (p &lt; 0.05).&#x0D; Conclusion: The combined application of PPSF and THD in patients with thoracolumbar fractures ameliorates postoperative pain levels, improves short-term spinal function, and significantly alters the postoperative coagulation index of patients, presumably by reducing the incidence of postoperative thrombosis. However, there is a need for further clinical trials prior to the introduction of this therapy into clinical practice.

C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position.

Oblique lumbar interbody fusion (OLIF) is an established technique for the indirect decompression of lumbar canal stenosis. However, OLIF at the L5-S1 level (OLIF51) is technically difficult because of the anatomical structures. We present a novel simultaneous technique of OLIF51 with percutaneous pedicle screw fixation without fluoroscopy. The patient is placed in a right lateral decubitus position. A percutaneous reference pin is inserted into the right sacroiliac joint. An O-arm scan is performed, and 3D reconstructed images are transmitted to the spinal navigation system. A 4 cm oblique skin incision is made under navigation guidance along the pelvis. The internal/external and transverse abdominal muscles are divided along the muscle fibers, protecting the iliohypogastric and ilioinguinal nerves. Using a retroperitoneal approach, the left common iliac vessels are identified. Special muscle retractors with illumination are used to expose the L5-S1 intervertebral disc. After disc preparation with navigated instruments, the disc space is distracted with navigated trials. Autogenous bone and demineralized bone material are then inserted into the cage hole. The OLIF51 cage is inserted into the disc space with the help of a mallet. Simultaneously, percutaneous pedicle screws are inserted by another surgeon without changing the lateral decubitus position of the patient. In conclusion, C-arm-free OLIF51 and simultaneous percutaneous pedicle screw fixation are performed in a lateral position under navigation guidance. This novel technique reduces surgical time and radiation hazards.

C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position

Oblique lumbar interbody fusion (OLIF) is an established technique for the indirect decompression of lumbar canal stenosis. However, OLIF at the L5-S1 level (OLIF51) is technically difficult because of the anatomical structures. We present a novel simultaneous technique of OLIF51 with percutaneous pedicle screw fixation without fluoroscopy. The patient is placed in a right lateral decubitus position. A percutaneous reference pin is inserted into the right sacroiliac joint. An O-arm scan is performed, and 3D reconstructed images are transmitted to the spinal navigation system. A 4 cm oblique skin incision is made under navigation guidance along the pelvis. The internal/external and transverse abdominal muscles are divided along the muscle fibers, protecting the iliohypogastric and ilioinguinal nerves. Using a retroperitoneal approach, the left common iliac vessels are identified. Special muscle retractors with illumination are used to expose the L5-S1 intervertebral disc. After disc preparation with navigated instruments, the disc space is distracted with navigated trials. Autogenous bone and demineralized bone material are then inserted into the cage hole. The OLIF51 cage is inserted into the disc space with the help of a mallet. Simultaneously, percutaneous pedicle screws are inserted by another surgeon without changing the lateral decubitus position of the patient. In conclusion, C-arm-free OLIF51 and simultaneous percutaneous pedicle screw fixation are performed in a lateral position under navigation guidance. This novel technique reduces surgical time and radiation hazards.

P122. Comparing long term deformity correction and other outcomes between single level circumferential XLIF and MI-TLIF: a retrospective review with 5-year minimum follow up

<h3>BACKGROUND CONTEXT</h3> XLIF with percutaneous pedicle screw fixation (circumferential XLIF) and MI-TLIF are two commonly used minimally invasive approaches to the lumbar spine. Because of its lateral approach, traditional XLIF is blocked to the L5-S1 disc space by the iliac crest. Studies that have compared these two techniques typically do not account for this limitation and, furthermore, tend to not restrict their analysis by number of levels operated on. Additionally, studies evaluating long term (>5-year) outcomes of these techniques are less numerous. Therefore, this study aims to compare the clinical and radiological outcomes of single level circumferential XLIF and MI-TLIF exclusively at the L4-L5 disc space. <h3>PURPOSE</h3> To compare the clinical and radiological outcomes of single level XLIF and MI-TLIF at L4-L5. <h3>STUDY DESIGN/SETTING</h3> Retrospective comparative study. <h3>PATIENT SAMPLE</h3> A total of 108 total patients (75 MI-TLIF and 33 circumferential XLIF) that underwent single level surgery at L4-L5 at a single institution from 2008 to 2015 with a minimum of 5-year follow up. <h3>OUTCOME MEASURES</h3> 1) Patient demographics: age, sex, BMI, length of follow up; 2) rate of complications requiring a return to the OR (RTO); 3) Radiographic outcomes: graft subsidence, final anterior and posterior disc height (ADH and PDH); 4) Patient outcome scores: Oswestry Disability Index (ODI), Visual Analogue Scale (VAS). <h3>METHODS</h3> A retrospective review was performed to identify all patients between 2008-2015 who underwent circumferential XLIF or MI-TLIF with a minimum followup of 5 years. Demographic data, complication-related data, radiographic outcomes and patient outcome scores were recorded and compared between cohorts. Standard binominal and categorical comparative analyses were performed. <h3>RESULTS</h3> A total of 108 patients were included for analysis (75 MI-TLIF and 33 circumferential XLIF). Mean age (53.5 MI-TLIF and 53.9 XLIF), BMI (32.3 MI-TLIF and 31.4 XLIF), and length of follow up (90 months MI-TLIF and 103 months XLIF) were similar between cohorts. Overall RTO rate was found to be statistically similar between groups at 16.0% (95% CI, 9.24-26.07) in the MI-TLIF group and 6.1% (95% CI, 0.68-20.60) in the XLIF group. Final ADH was 9.03±1.10 mm in the MI-TLIF group and 12.3±2.60 mm in the XLIF group (p < 0.0001). Final PDH was 9.97±1.96 mm for MI-TLIF and 7.12±2.2 mm for XLIF (p < 0.0001). Average DH was 9.50±1.59 mm and 9.71±2.41 mm for the MI-TLIF and XLIF groups, respectively (p=0.593). Change in ODI and VAS scores at final follow up were similar between MI-TLIF and XLIF groups (p=0.629 for ODI and p=0.322 for VAS). <h3>CONCLUSIONS</h3> This long-term comparative study demonstrates similar clinical and radiological outcomes between single level MI-TLIF and circumferential XLIF at the L4-L5 level. As expected, MI-TLIF had significantly greater long-term improvement in posterior disc height and XLIF had significantly greater improvement in anterior disc height. However, average disc height was found to be similar between groups. This suggests that although MI-TLIF and circumferential XLIF lead to equivalent long-term improvement at the L4-L5 level, choosing one's approach based on the anterior versus posterior disc anatomy of the patient may enhance patient outcome. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

P130. Lateral single position anterior posterior (AP) lumbar fusion outperforms conventional AP fusion with patient repositioning at 2-year minimum follow-up

<h3>BACKGROUND CONTEXT</h3> Previous literature has demonstrated the advantages of lateral single position surgery (L-SPS) in the perioperative period; however, 2-year postoperative outcomes of this novel technique have not yet been compared to circumferential anterior-posterior fusion (FLIP) at 2-years postoperatively. <h3>PURPOSE</h3> Evaluate the feasibility and safety of L-SPS technique against the conventional FLIP. <h3>STUDY DESIGN/SETTING</h3> Multi-center retrospective cohort study. <h3>PATIENT SAMPLE</h3> Patients undergoing primary AP (ALIF or LLIF) fusions with bilateral percutaneous pedicle screw fixation between L2-S1 with minimum 2-year followup at three institutions. <h3>OUTCOME MEASURES</h3> Outcome measures included levels fused, operative time, estimated blood loss and perioperative complications. Radiographic analysis included lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), PI-LL mismatch and segmental lumbar lordosis. <h3>METHODS</h3> Patients were grouped as L-SPS if anterior and posterior portions of the procedure were performed in the lateral decubitus position, and FLIP if patients were repositioned from supine or lateral to prone position for the posterior portion of the procedure. Groups were compared in terms of demographics, intraoperative, perioperative and radiological outcomes, complications and reoperations up to 2 years follow-up. Measures were compared using independent samples or paired t-tests and chi-squared analyses with significance set at p<0.05. <h3>RESULTS</h3> A total of 442 pts met inclusion, including 352 L-SPS and 90 FLIP pts. Significant differences were noted in age (62.4 vs. 56.9; p=< 0.001) and smoking status (7% vs. 16%; p=0.023) between the L-SPS and FLIP groups. No differences between L-SPS and FLIP were noted in gender (57.4% female vs 57.8% female, p=1.000), BMI (30.0kg/m2 vs 29.3kg/m2; p=0.318). No differences were noted in number of levels fused between L-SPS and FLIP (1.45vs 1.50; p=0.533), proportion including ALIF (38% vs 39%; p=0.809), or the proportion of surgeries including L5-S1 (38%vs 31%; p=0.222). Perioperative outcomes: L-SPS demonstrated significantly lower Op time (97.7min vs 297.0 min; p < 0.001), fluoro dose (36.5mGy vs 78.8mGy; p < 0.001), EBL (88.8mL vs 270.0mL; p < 0.001), and LOS (1.91 days vs. 3.61 days; p < 0.001) compared to FLIP. L-SPS also demonstrated significantly fewer post-op complications than FLIP (21.9% vs 34.4%; p=0.013), specifically regarding rates of ileus (0.0% vs 5.6%; p < 0.001). There was no difference in remaining surgical site, neurological, or medical complications between groups. Reoperation: N=no differences in reoperation were noted at 30-day (1.7%L-SPS vs 4.4%FLIP, p=0.125), 90-day (5.1%L-SPS vs 5.6%FLIP, p=0.795) or 2-year follow-up (9.7%L-SPS vs 12.2%FLIP; p=0.441). The most common reason for return to OR was Adjacent Segment Disease, (L-SPS 3.1% vs. FLIP 7.8%; p=0.067). Pseudarthrosis rates were similar between groups (0.0%L-SPS vs. 1.1%FLIP; p=0.204). Radiological Outcomes: no significant differences were noted in rates of radiological fusion (94.3% L-SPS vs 97.8%FLIP; p=0.266) or subsidence (6.9%L-SPS vs 12.2%FLIP; p=0.260). There were no differences noted between L-SPS and FLIP in change in LL from Baseline to 1-year (3.5 vs 2.8; p=0.466) and post-op to 1yr (-0.18 vs -0.51; p=0.777), or in PI-LL from Baseline to 1-year (-3.5 vs -3.2; p=0.835) and from post-op to 1-year (0.71 vs 0.71; 0.998). <h3>CONCLUSIONS</h3> L-SPS improves safety, improves operative efficiency and reduces complications in the perioperative period while maintaining similar efficacy of AP fusion at 2-year followup in treating degenerative lumbar spinal conditions. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Minimally Invasive Spinal Treatment (MIST)-A New Concept in the Treatment of Spinal Diseases: A Narrative Review.

In the past two decades, minimally invasive spine surgery (MISS) techniques have been developed for spinal surgery. Historically, minimizing invasiveness in decompression surgery was initially reported as a MISS technique. In recent years, MISS techniques have also been applied for spinal stabilization techniques, which were defined as minimally invasive spine stabilization (MISt), including percutaneous pedicle screws (PPS) fixation, lateral lumbar interbody fusion, balloon kyphoplasty, percutaneous vertebroplasty, cortical bone trajectory, and cervical total disc replacement. These MISS techniques typically provide many advantages such as preservation of paraspinal musculature, less blood loss, a shorter operative time, less postoperative pain, and a lower infection rate as well as being more cost-effective compared to traditional open techniques. However, even MISS techniques are associated with several limitations including technical difficulty, training opportunities, surgical cost, equipment cost, and radiation exposure. These downsides of surgical treatments make conservative treatments more feasible option. In the future, medicine must become “minimally invasive” in the broadest sense—for all patients, conventional surgeries, medical personnel, hospital management, nursing care, and the medical economy. As a new framework for the treatment of spinal diseases, the concept of minimally invasive spinal treatment (MIST) has been proposed.

PERCUTANEOUS CD FIXATION OF SPINE IN SPINAL FRACTURES/ INSTABILITY BY FREE HAND TECHNIQUE

Introduction: Lumbar spondylolisthesis is frequently found in adults as a result of spondylolysis or facet degeneration. The slipped segment produces abnormal positioning of the vertebrae in relation to each other along the spinal column and causes mechanical back pain and compression of neural structures. The initial treatment in most symptomatic patients with lumbar spondylolisthesis is nonoperative supportive care, which consists of a combination of pain medications, bracing, and physical therapy. Surgical intervention is indicated if the symptoms are disabling and they interfere with work despite supportive care, if there is progression of the slippage degree (SD) on serial radiologic examinations, or if there are overt neurological deficits 1,2. Pedicle screw placement is the most popular method in lumbar spinal instrumentation for achieving successful fusion. Recently, to reduce surgical damage to the normal muscular structures during pedicle screw placement, C-arm-guided percutaneous pedicle screw fixation (PPSF) was introduced, and it has become increasingly popular in spinal surgery. Percutaneous transpedicular fixation systems have become more widely used in recent years mainly for the treatment of dorsal, dorsolumbar, and lumbar instability. Aim &amp; Objectives: The present study is aimed at evaluating the functional outcome with percutaneous pedicle screw fixation for spinal fractures&amp; spinal instabilities by free hand technique in patients without neurological deficits. Materials &amp; Methods: The present dissertation is a study of 25 consecutive cases of spinal fractures and spondylolisthesis who attended the orthopaedic emergency or outpatient department of Andhra medical college, Visakhapatnam from 2017 to 2019. All the cases were examined clinically fallowed by radiographic confirmation. Results: In total 25 patients spinal fractures 16 and instability 9, whose mean preoperative ODI scores is 81.04% and the mean postoperative score is 22.6 %. The total postoperative moderate disability patients are15 and minimal disability patients are 10. “PERCUTANEOUS CD FIXATION OF SPINE IN SPINAL FRACTURES/INSTABILITY BY FREEConclusion: HAND TECHNIQUE” is one of the better methods and is suggested for grade 1 &amp; grade 2 spondylolisthesis and spinal fractures, also by which can reduce the morbidity and improve the function.

The Efficiency and Reliability of Minimally Invasive Anterior Corpectomy and Percutaneous Posterior Stabilization for the Treatment of Unstable Thoracolumbar Burst Fractures

The purpose of this study was to evaluate the radiological and clinical outcomes of minimally invasive anterior corpectomy and percutaneous posterior stabilization for treating unstable thoracolumbar burst fractures. Patients with unstable thoracolumbar burst fractures who underwent minimally invasive anterior corpectomy and percutaneous posterior stabilization between 2012 and 2019 at a tertiary hospital were enrolled. Radiological outcomes such as endplate subsidence and fusion status were identified on preoperative and postoperative plain radiographs and computed tomography images. Preoperative and postoperative neurological statuses were evaluated using the American Spinal Injury Association impairment scale. Furthermore, operation-related parameters were analyzed. In total, 21 patients (mean follow-up period, 21.7months) were included in this study. Of them, 17 (80.95%) patients exhibited complete fusion according to the Bridwell's criteria at the final follow-up, and only 1 patient exhibited nonunion at the surgical level. Endplate subsidence was observed in 6 (28.57%) patients; however, there were no definite symptoms that would have necessitated a revision surgery. Of 15 patients with preoperative neurological impairment, 7 exhibited neurological improvement during follow-up. None of the patients experienced postoperative neurological deterioration. Regarding operation-related parameters, the mean operative time and intraoperative blood loss were 266.19±51.54min and 520.71±190.86ml, respectively. The mean length of hospital stays and days to postoperative ambulation were 12.14 and 4.20days, respectively. Minimally invasive anterolateral corpectomy with percutaneous pedicle screw fixation is a reliable surgical treatment option for unstable thoracolumbar burst fractures.

Percutaneous pedicle screw fixation without arthrodesis of 368 thoracolumbar fractures: long-term clinical and radiological outcomes in a single institution.

Traumatic thoracolumbar (TL) fractures are the most common vertebral fractures. Although a consensus on the preferred treatment is missing, percutaneous pedicle screw fixation (PPSF) has been progressively accepted as treatment option, since it is related to lower soft tissues surgical-injury and perioperative complications rate. This study aims to evaluate the long-term clinical-radiological outcomes after PPSF for TL fractures at a single tertiary academic hospital. This is a retrospective cohort study. Back pain was obtained at preoperative, postoperative and final follow-up using Visual Analog Scale. Patient-reported outcomes, the Oswestry Disability Index and the 36-Item Short Form, were obtained to asses disability during follow-up. Radiological measures included Cobb angle, mid-sagittal index, sagittal index (SI) and vertebral body height loss. A multivariate regression analysis on preoperative radiological features was performed to investigate independent risk factors for implant failure. A total of 296 patients with 368 TL fractures met inclusion criteria. Mean follow-up was 124.3months. The clinical and radiological parameters significantly improved from preoperative to last follow-up measurements. The multivariate analysis showed that Cobb angle (OR = 1.3, p < 0.001), SI (OR = 1.5, p < 0.001) and number of fractures (OR = 1.1, p = 0.05), were independent risk factors for implant failure. The overall complication rate was 5.1%, while the reoperation rate for implant failure was 3.4%. In our case series, PPSF for TL injuries demonstrated good long-term clinical-radiological outcomes, along with low complication and reoperation rates. Accordingly, PPSF could be considered as a valuable treatment option for neurologically intact patients with TL fractures. Additionally, in this cohort, number of fractures ≥ 2, Cobb angle ≥ 15° and sagittal index ≥ 21° were independent risk factors for implant failure.

Single-position circumferential lumbar spinal fusion: an overview of terminology, concepts, rationale and the current evidence base.

To provide definitions and a conceptual framework for single position surgery (SPS) applied to circumferential fusion of the lumbar spine. Narrative literature review and experts' opinion. Two major limitations of lateral lumbar interbody fusion (LLIF) have been (a) a perceived need to reposition the patient to the prone position for posterior fixation, and (b) the lack of a robust solution for fusion at the L5/S1 level. Recently, two strategies for performing single-position circumferential lumbar spinal fusion have been described. The combination of anterior lumbar interbody fusion (ALIF) in the lateral decubitus position (LALIF), LLIF and percutaneous pedicle screw fixation (pPSF) in the lateral decubitus position is known as lateral single-position surgery (LSPS). Prone LLIF (PLLIF) involves transpsoas LLIF done in the prone position that is more familiar for surgeons to then implant pedicle screw fixation. This can be referred to as prone single-position surgery (PSPS). In this review, we describe the evolution of and rationale for single-position spinal surgery. Pertinent studies validating LSPS and PSPS are reviewed and future questions regarding the future of these techniques are posed. Lastly, we present an algorithm for single-position surgery that describes the utility of LALIF, LLIF and PLLIF in the treatment of patients requiring AP lumbar fusions. Single position surgery in circumferential fusion of the lumbar spine includes posterior fixation in association with any of the following: lateral position LLIF, prone position LLIF, lateral position ALIF, and their combination (lateral position LLIF+ALIF). Preliminary studies have validated these methods.

Outpatient outcomes of patients with femoral nerve neurapraxia after prone lateral lumbar interbody fusion at L4-5.

Single-position prone lateral lumbar interbody fusion (LLIF) improves the efficiency of staged minimally invasive lumbar spine surgery. However, laterally approaching the lumbar spine, especially L4-5 with the patient in the prone position, could increase the risk of complications and presents unique challenges, including difficult ergonomics, psoas migration, and management of the nearby lumbar plexus. The authors sought to identify postoperative femoral neurapraxia after single-position prone LLIF at L4-5 to better understand how symptoms evolve over time. This retrospective analysis examined a prospectively maintained database of LLIF patients who were treated by two surgeons (J.S.U. and J.D.T.). Patients who underwent single-position prone LLIF at L4-5 and percutaneous pedicle screw fixation for lumbar stenosis or spondylolisthesis were included if they had at least 6 weeks of follow-up. Outpatient postoperative neurological symptoms were analyzed at 6-week, 3-month, and 6-month follow-up evaluations. Twenty-nine patients (16 women [55%]; overall mean ± SD age 62 ± 11 years) met the inclusion criteria. Five patients (17%) experienced complications, including 1 (3%) who had a femoral nerve injury with resultant motor weakness. The mean ± SD transpsoas retractor time was 14.6 ± 6.1 minutes, the directional anterior electromyography (EMG) threshold before retractor placement was 20.1 ± 10.2 mA, and the directional posterior EMG threshold was 10.4 ± 9.1 mA. All patients had 6-week clinical follow-up evaluations. Ten patients (34%) reported thigh pain or weakness at their 6-week follow-up appointment, compared with 3/27 (11%) at 3 months and 1/20 (5%) at 6 months. No association was found between directional EMG threshold and neurapraxia, but longer transpsoas retractor time at L4-5 was significantly associated with femoral neurapraxia at 6-week follow-up (p = 0.02). The only case of femoral nerve injury with motor weakness developed in a patient with a retractor time that was nearly twice as long as the mean time (27.0 vs 14.6 minutes); however, this patient fully recovered by the 3-month follow-up evaluation. To our knowledge, this is the largest study with the longest follow-up duration to date after single-position prone LLIF at L4-5 with percutaneous pedicle screw fixation. Although 34% of patients reported ipsilateral sensory symptoms in the thigh at the 6-week follow-up evaluation, only 1 patient sustained a nerve injury; this resulted in temporary weakness that resolved by the 3-month follow-up evaluation. Thus, longer transpsoas retractor time at L4-5 during prone LLIF is associated with increased ipsilateral thigh symptoms at 6-week follow-up that may resolve over time.

Minimally Invasive Surgery for Spinal Metastases

The incidence of metastatic spine disease (MSD) is on the rise and is currently present in 70% of patients presenting with systemic cancer. The majority of patients with MSD present with clinical symptoms such as neurological deficit, pathological fracture causing pain and spinal instability. Management of MSD is a multidisciplinary endeavor that involves surgery, radiotherapy (RT), and chemotherapy. The conventional open spine surgery approach has evolved into a less invasive surgery model categorized as minimally invasive spine surgery (MISS) or minimal access spine surgery. This evolution was brought about to address the complications associated with open surgery such as longer hospital stays and wound-related problems. MISS has been now widely explored in MSD due to lower wound-related complications, decreasing operative time, less neurological complications, and shorter hospital stays. Decompression and stabilization still remain the core concepts in MISS. Kyphoplasty/vertebroplasty, percutaneous pedicle screw fixation, separation surgery, and radiofrequency ablation are some of the minimally invasive techniques and procedures for surgical management of MSD. MISS is used in conjunction with other modern techniques like intraoperative neuromonitoring to help identify any adverse neurological events. MIS techniques will evolve with time, extending their application for the management of hypervascular tumors with significant anterior cord compression and recurrent tumors in which the open surgery currently remains the choice of approach.