Percutaneous Transpedicular Screw Fixation Research Articles

Evaluation of minimally invasive percutaneous transpedicular screw fixation as an evolving modality for the treatment of thoracolumbar fractures

BackgroundPercutaneous transpedicular screw fixation was recently introduced as a minimally invasive approach for the treatment of thoracolumbar spine fracture. This approach is superior to the traditional open surgical approaches in decreasing intraoperative blood loss, infection rates, and paraspinal muscle damage with less hospital stay.ObjectiveThis study aims to report our surgical experience, the feasibility and safety of percutaneous transpedicular screw fixation of thoracolumbar spine fractures.Methodwe retrospectively reviewed the charts of all adult patients with thoracolumbar spine fractures who underwent percutaneous transpedicular screw fixation during the period between January 2020 to January 2023 at Ain Shams University Hospitals and Prince Mohamed Ibn Abdelaziz Hospital. Collected data included: demographics, pre- and postoperative neurological assessment, radiological data including type of fracture and cobb’s angle pre- and postoperatively, operative time and amount of intraoperative blood loss.ResultsForty-three percutaneous pedicle screw fixation procedures were done for 42 patients. Thirty patients were males. Dorsal spine fractures accounted for 18 cases. Preoperative American spinal injury Association score was E in 37 cases. Mean operative time was 133 min (± 46.5), and mean intraoperative blood loss was 107.1 ml (± 84). The mean follow-up period was 8 months, and the average hospital stay was 7.7 days. Radiological complete bony fusion was achieved in 77% of fractures, and 93% had improved kyphotic angle with a mean correction degree of 7.9 (± 9).ConclusionPercutaneous transpedicular screw fixation is a safe and effective treatment option for the management of thoracolumbar spine fractures with or without spine decompression that provides satisfactory functional outcomes.

Unilateral biportal endoscopic technique combined with percutaneous transpedicular screw fixation for thoracolumbar burst fractures with neurological symptoms: technical note and preliminary report

BackgroundPrevious studies on thoracolumbar fractures with neurological symptoms have focused on how to achieve satisfactory fracture reduction, adequate nerve decompression, and stable spinal alignment. With the development of the minimally invasive spine surgery technique, achieving satisfactory treatment results and reducing iatrogenic trauma at the same time has become a new goal of spinal surgery. This research used percutaneous transpedicular screw distraction to partially reduce the fractured vertebrae, followed by completing nerve decompression and reducing residual displacement bone fragments with the assistance of the unilateral biportal endoscopic (UBE) technique to achieve full protection of bone-ligament tissue and obtain good clinical efficacy.MethodsGuide wires were safely inserted into the fractured vertebra and adjacent upper and lower vertebra under the surveillance of anteroposterior and lateral X-ray fluoroscopy. Transpedicular screws were implanted via guide wires on the side with mild neurological deficits or bone fragment compression (the opposite side of the endoscopic operation). A titanium rod was installed and moderately distracted to reduce the fractured vertebra. Then, under the guidance of the endoscopic view, the laminectomy and ligamentum flavum resection were completed according to the position of the protruding bone fragment into the spinal canal, and the compressed dural sac or nerve root was fully exposed and decompressed. An L-shaped replacer was used to reduce residual bone fragments. The ipsilateral transpedicular screws and rod were installed and adjusted to match the contralateral side. The drainage tube was indwelled, and the incision was closed. The preoperative and postoperative images of the patients were evaluated, and the recovery of neurological symptoms was observed.ResultsSurgery was successfully completed on all six patients, and no intraoperative conversion to open surgery was performed. Postoperative images showed good reduction of the protruding bone fragment and good placement of all screws. At the last follow-up, the neurological symptoms of all patients returned to normal.ConclusionThe UBE technique combined with percutaneous transpedicular screw fixation in the treatment of thoracolumbar fractures with neurological symptoms can effectively achieve the reduction of displaced bone fragments, improve damaged nerve function, stabilize spinal alignment, and protect the integrity of bone-ligament tissue.

Transpedicular Screw Fixation of Traumatic Thoracolumbar Spine Fracture Open Versus Percutaneous Technique

Objective: To determine meantime to return to work of patients with traumatic thoracolumbar spine fracture managed with open versus percutaneous trans-pedicular screw fixation. Materials and methods: A randomized controlled trial conducted in a joint venture of orthopedic and neurosurgeons in a private hospital of Lahore. Study was completed in six months duration from July to December 2022. 80 patients having traumatic thoracolumbar spine fractures presenting to the study hospital and falling in inclusion criteria were enrolled into this study. Two groups made containing equal number of patients in each (n=40). One group underwent open transpedicular screw fixation and other group underwent percutaneous trans-pedicular screw fixation. Monthly follow up was done and the time taken return to work (TTRW) was noted. Results: Mean age of the patients was 34.62 years. There were 40(50%) male and 40(50%) female patients in the study group (n=80). Mean time taken return to work after the surgery was 3.1±0.61 months in group-A (percutaneous screw fixation) versus 5.2±0.84 months in group-B (open screw fixation). The difference in two groups regarding TTRW was significant (p<0.005). Male and female patients showed significant difference in TTRW within group-A (p=0.021) while no significance difference found in TTRW among male and female patients within group-B (p=0.18). Duration of the procedure had significant impact on TTRW (p=0.001). Practical Implication: Percutaneous technique has been proved to be safer, quicker and minimal invasive method that should replace open technique. It is recommended to conduct comparative randomized controlled trials on larger study groups to obtain more data regarding outcomes of percutaneous versus open technique. This study helps us to understand comparatively safety, efficacy and feasibility of both techniques so that better treatment option may be used in such patients for better outcomes. Conclusion: We concluded that time taken return to work was shorter in the patients treated by percutaneous technique of transpedicular screw fixation versus those patients treated by open technique. Percutaneous technique has shorter duration of the procedure, less morbidity, early recovery and more effective. Keywords: Transpedicular screw fixation, Thoracolumbar spine fracture, Spinal cord injury, Time taken return to work

Hidden blood loss and its influencing factors after minimally invasive percutaneous transpedicular screw fixation in thoracolumbar fracture

BackgroundMinimally invasive percutaneous transpedicular screw fixation (MIPTSF) is generally accepted as a minimally invasive treatment for thoracolumbar fracture. However, hidden blood loss (HBL) caused by this procedure is usually disregarded. This study aimed to investigate the amount of HBL and its influencing factors after MIPTSF in thoracolumbar fracture.MethodsBetween October 2017 and December 2020, a total of 146 patients (106 males and 40 females, age range 21–59 years) were retrospectively examined, and their clinical and radiological data were recorded and analyzed. The Pearson or Spearman correlation analysis was used to investigate an association between patient’s characteristics and HBL. Multivariate linear regression analysis was performed to elucidate the related clinical or radiological factors of HBL.ResultsA substantial amount of HBL (164.00 ± 112.02 ml, 40.65% of total blood loss (TBL)) occurred after transpedicular screw internal fixation. Multivariate linear regression analysis revealed that HBL was positively associated with TBL (p < .001), percentage of vertebral height loss (VHL) (p < .001), percentage of vertebral height restoration (VHR) (p < .001), numbers of fractured vertebrae (P = .013), and numbers of fixed vertebral segments (P = .002).ConclusionA large amount of HBL was incurred in patients undergoing MIPTSF in thoracolumbar fracture. More importantly, TBL, percentage of VHL, percentage of VHR, the numbers of fractured vertebrae and fixed vertebral segments were independent risk factors for HBL.

The Outcome of Minimally Invasive Percutaneous Transpedicular Screw Fixation (TPSF) in Thoracolumbar Spine Fractures

Background &amp; Objective: This study aimed to determine the outcome of percutaneous transpedicular screw fixation (TPSF) in patients with thoracolumbar fractures.&#x0D; Material &amp; Methods: A total of 157 patients with thoracolumbar fractures were included from the Department of Neurosurgery, LGH, PINS, Lahore. Patients were evaluated with plain X-rays, CT, and MRI scans. Neurological status was documented preoperatively and postoperatively. All patients were treated with Minimally Invasive Percutaneous Transpedicular screw fixation. Data for operative time and per-operative blood loss was obtained through the operative notes. The severity of postoperative pain and length of hospital stay were also documented.&#x0D; Results: Out of 157 patients, 69.4% were male and 30.6% were female. The 141 (89.8%) were traumatic from road traffic accidents/falls, and 16 (10.2%) were pathologic. The 128 (81%) patients were discharged on the first day, 23(15%) were discharged on the second day, and 6(3.8%) on the third day. 79% of patients had a single level of spine fracture whereas, 20% had 2 spinal fracture levels. The average operative time for MIS percutaneous TPSF was 55 minutes. Postoperative pain was markedly reduced as compared to traditional open surgery and no patient had any new neurological deficit. The mean blood loss was 25 ml and none of the patients needed a postoperative blood transfusion.&#x0D; Conclusion: Percutaneous transpedicular instrumentation is an ideal surgical approach for thoracolumbar spinal stabilization.&#x0D; Keywords: Thoracolumbar Fractures, Percutaneous Transpedicular Screw Fixation, Minimally Invasive Spine Surgery, Road Traffic Accidents (RTA).

Minimally Invasive Transpedicular Screw Fixation: Review of 152 Cases in a Single Institution. Steep or Shallow Learning Curve?

In this study, we analyze our institutional experience and personal impressions using minimally invasive spine surgery (MISS) to describe our learning curve and how experience influenced different parameters of the surgical procedure. The study was conducted prospectively and included the first consecutive 152 patients treated with MISS techniques. Patient demographics, surgical data, length of hospital stay, and clinical outcome were reviewed. The cohort was divided into consecutive quarters. Comparison between the quarters and timeline analysis were made to assess the learning curve. Only percutaneous transpedicular screw fixation was performed in 65 cases, minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in 70 cases, and vertebral body replacement in 4 cases. The average blood loss was 113.3, 115, 106.6, and 107.1 mL for each quarter. The average operative time was 155.0, 143.2, 134.5, and 133.8 minutes for the four quarters, whereas the average radiation exposure time was 105.4, 85.3, 46.2, and 45.2 seconds. Differences in the operative time and radiation exposure time between the first to third and the first to fourth quarters were statistically significant. Some advantages of MISS techniques could be observed with the very first cases and were not related significantly with the surgeon's experience with MISS. With the acquisition of more experience, some disadvantages of MISS techniques such as longer operative time and longer X-ray exposure can be substantially reduced. Surgical experience, familiarity of the team with the MISS instrumentation, and good patient selection are crucial for achieving all the benefits of MISS.

Early Experience with Percutaneous Transpedicular Screw Fixation for Thoracolumbar Fractures at a Tertiary Hospital in Pakistan.

Objective: To present our early experience with percutaneous transpedicular screw fixation for thoracolumbar fractures at a tertiary care hospital in Pakistan.&#x0D; Material &amp; Methods: A case series of 20 patients with thoracolumbar fractures, who met the inclusion and exclusion criteria were followed for up to six months to evaluate their functional status using the Oswestry Disability Index (ODI). Kendall’s tau, Spearman’s rho and Pearson correlations were conducted to draw useful conclusions.&#x0D; Results: 85% patients’ injury was reported from ‘fall from height’. 55% of the fracture was the dorsal-lumbar junction (T12-L1). Burst type morphology was reported in maximum number of patients (65%). 55% of patients were reported to be neurologically intact. ODI score’s mean percentage decreased from 40% to 23% during the first week to six months, indicates an improvement in the disabilities. A significant (p&lt;0.050) positive correlation was found between fracture morphology and ODI. All patients had an accurate screw trajectory postoperatively and no postoperative complications were documented. Neurology was stable for all patients at 1, 3 and 6 months.&#x0D; Conclusion: Percutaneous transpedicular screw fixation can be a viable approach for thoracolumbar burst fractures with intact posterior ligamentous complex in all types of thoracolumbar fractures, including type C and leads to an improvement the quality of life. Fracture morphology has a significantly positive correlation with a higher disability index score, with more severe fracture morphologies as per the Thoracolumbar Injury Classification and Severity (TLICS) score having a higher disability.

Percutaneous screw fixation assisted by an orthopedic robot for pelvic and acetabular fractures

Objective To analyze the effectiveness and safety of percutaneous screw fixation assisted by an orthopedic robot for treatment of pelvic and acetabular fractures. Methods Fifteen patients with fresh closed pelvic or acetabular fracture were hospitalized from September to December 2017 at Department of Orthopaedics, Foshan Hospital of Traditional Chinese Medicine. They were 10 men and 5 women, from 22 to 69 years of age (average, 65.2 years). There were 9 pelvic fractures (5 cases of Tile type B and 4 ones of Tile type C) and 6 acetabular fractures (3 anterior column fractures, 2 posterior column fractures and one transverse fracture). All patients underwent percutaneous transpedicular screw fixation with the assistance of an orthopaedic robot. Fluoroscopic frequency, number of guide needle adjustment and deviation between initial planning and the final screw position were recorded intraoperatively. Postoperative CT was performed to eval-uate screw positions and incidence of adverse events. Functional recovery in the patients was evaluated in regular follow-ups. Results A total of 26 screws were implanted in the operation. The fluoroscopic fre-quency ranged from 12 to 49 times, with a mean value of 17.3 times per screw; the number of needle ad-justment ranged from 0 to 2 times(mean, 0.3 times); the deviation of the actual path from its initial plan-ning ranged from 0.82 to 1.42 mm (mean, 1.06 mm). No surgery-related neurovascular injury occurred in any patient. Postoperative CT examination revealed that no screws cut out of cortical bone, yielding a 100% rate of excellent and good screw positions. Two patients were lost to the follow-up, and the re-maining 13 patients were followed up for 12 to 14 months (mean, 12.6 months). Their Majeed functional scores at the final follow-up averaged 88.6 points (from 68 to 96 points). No neurological symptoms were observed during follow-up. Conclusion Since percutaneous screw fixation assisted by an orthopaedic robot is accurate and safe and needs less fluoroscopic frequency, it will became a major minimally invasive surgical technique for pelvic and acetabular fractures. Key words: Pelvis; Acetabulum; Fractures, bone; Fracture fixation, internal; Robot

Value of Combination of Two Minimal Invasive Techniques in Elderly Patients with Multisegmental Lumbar Canal Stenosis and Spondylosis. Midterm Results

Introduction Lumbar canal stenosis (LCS) and spondylosis are the major causes of morbidity among the elderly. LCS remains the most common indication for spinal surgery in elderly patients. These patients are complaining from neurogenic claudication as well as back complaint. LCS remains the most common indication for spinal surgery in elderly patients. These patients are complaining from neurogenic claudication as well as back complaint. Although the decompression Procedures improve the claudication, the back complaint persist or even increase. We assess the efficacy of combination of microscopic assisted percutaneous decompression (MAPD) and percutaneous transpedicular screw fixation (TPSF) with PEEK rod. Material and Methods Prospective study. Between 2009 and June 2012, 20 Patients with LCS and lumbar spondylosis were included in this study. We reviewed demographic information, preoperative (preop.) and postoperative (postop.) Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Results 20 patients (14 males and 6 females; mean age 69.2 years), mean follow-up 14.2 months, co-morbidities are found in patients (cardiac 8, DM in 4, renal insufficiency in 4), ASA Score (Class I in 8, III in 10, III in 2). BMI; normal weight (7), overweight (6) and Obesity (7). Mean preop. VAS (back and leg) was 5.5 and 5.6 respectively; ODI was 57.2%, 3 months postop. VAS (2.65 and 1.3), ODI 26.4% and 18.2% at the last follow-up. The operated levels were (one level in 2 patients, two levels in 7, three levels in 7 and four levels in 4), eight patients with degenerative scoliosis (more than 10°) with mean cobb- angle of 15.4° preop. and postop. 5.75°. Mean Lumbar lordosis was 35.6° preop. and 39.5° postop. Sacral Slope was 27.8°preop. and postop. 30.3°. Mean operative time was 196 minutes and blood loss was 233.5 ml. Intraop. complications included 2 patients with dural injuries, no wound healing, Follow-up complications included one case with screw loosening. Conclusion Elderly patients are considered good candidates for lumbar surgical decompression using minimally invasive techniques. MAPD is a minimally invasive treatment option that affords a high level of safety, improved functions and decreased pain score. The spinal stabilization using PEEK rod possesses a good solution for spondyolotic back pain not

Percutaneous Transpedicular Fixation: Technical tips and Pitfalls of Sextant and Pathfinder Systems.

Study DesignThe efficacy of the operative techniques, possible benefits as well as pitfalls and limitations of the techniques are discussed. Potential drawbacks are also detected.PurposeThis study aims to report indications, techniques, and our experience with the use of the Sextant and PathFinder percutaneous transpedicular screw fixation systems.Overview of LiteraturePercutaneous pedicle screw insertion is a novel technique. Successful percutaneous placement of pedicle screws requires surgical skill and experience because of lack of anatomic surface landmarks. Fluoroscopy-guided percutaneous placement of pedicle screws is effective. Many systems are now available.MethodsWe conducted a prospective operative and postoperative analysis of 40 patients with absolute indication for thoracic or lumbar instability between January 2009 and June 2013. All procedures were performed with the Sextant (group A) and PathFinder (group B) systems under fluoroscopic guidance. Operative techniques are discussed and the results compared.ResultsPercutaneous transpedicular screw fixation minimizes the morbidity associated with open techniques without compromising the quality of fixation. A total of 190 screws were inserted. There was no additional morbidity. Postoperative computed tomography images and plain X-rays were analyzed. Reduction of visual analog scale scores of back pain was evident.ConclusionsFluoroscopy-guided percutaneous pedicular screws are feasible and can be safely done. Current systems allow multi-segmental fixation with significantly less difficulties. The described techniques have acceptable intra- and postoperative complication rates, and overall sufficient pain control with early mobilization of patients.

Minimally Invasive Percutaneous Transpedicular Screw Fixation of Acute Thoracolumbar Fractures

Background Data: Percutaneous transpedicular fixation systems have become more frequently used as it allows the surgeon to achieve same goals as standard open surgery but in a less invasive manner by insertion of pediclescrews and pre-contoured rods through a stab incision and elimination of the need for excessive muscle dissection.Purpose: The aim of this study is to evaluate the outcome of percutaneous fixation of acute thoracolumbar fractures.Study Design: A retrospective study. Patients and Methods: Retrospective review of patients with acute thoracolumbar fractures without neurological deficit treated with percutaneous fixation from January 2011 to January 2015. Baseline datainclude patient’s demographics, operative data, mechanism of injury, fracture level and kyphotic angle. Pain was assessed using visual analogue scale and radiological outcome was assessed as the amount of kyphotic angle correction.Results: Seventeen patients with thoracolumbar fractures were included in this study, 14 patients were male and 3 were female. The mean age ofthe patients was 41 years. The mode of fracture was fall from height in 13 patients and motor car accident in 4 patients. The mean operative time was 110 minute. The average hospital stay was 3 days. The mean kyphotic angle improved from 24 degrees before surgery to 7 degrees after surgery. The mean VAS improved from 8.4 preoperatively to 1.8 postoperatively. Conclusion: Fluoroscopic guided percutaneous transpedicular screw fixation can provide a safe and effective treatment for acute thoracolumbar fractures with significant reduction in blood loss,postoperative pain and hospital stay. (2015ESJ103)

Minimally Invasive Percutaneous Transpedicular Screw Fixation: Pros and Cons

Introduction The standard techniques for decompression, fixation, and fusion for various types of spinal disorders are well known. With the introduction of specific instrumentations, new alternative and minimally invasive techniques gain popularity, which in regard to clinical outcome and efficacy are comparable to standard approaches and even surpass them in some cases.

Percutaneous rotation-self oriented distraction trauma fixation system for treatment of thoracolumbar fractures

Objective To clarify the curative effect of percutaneous rotation-self oriented distraction trauma fixation system (RTS) in treatment of thoracolumbar fracture. Methods A prospective analysis was made on 52 patients with single segmental thoracolumbar fracture in the absence of neurological deficit treated from October 2011 to June 2013. Twenty-five patients were treated with Sextant percutaneous transpedicular screw fixation system manufactured by Sofamor Company (Sextant group), and the other 27 patients were treated using RTS made by Luoyang Orthopedic Hospital and Shanghai Ruizhi Company (RTS group). Two out of the patients in RTS group were lost to follow-up. Perioperative parameters of operation time and bleeding were compared between the two groups. Anterior and posterior height of fractured vertebrae and Cobb's angle were measured to estimate the correction of kyphotic deformity. Visual analogue score (VAS) and Oswestry disability index (ODI) were measured to evaluate the pain relief and function recovery. Results Duration of follow-up was 8-18 months (mean 13 months). Cobb's angle and anterior and posterior vertebral height between the two groups were similar before operation (P>0.05), but both groups obtained significant improvements after operation (P 0.05]. Anterior and posterior vertebral height showed (32.3±9.5)% and (5.7±1.6)% correction respectively in RTS group, but (19.6±10.7)% and (3.7±0.9)% in Sextant group (P 0.05). There were significant differences in VAS and ODI between the two group at postoperative 3 and 6 months and at final follow-up (P<0.01). Conclusion The two transpedicular screw fixation techniques are effective in treatment of thoracolumbar fracture, but RTS has better ability in vertebral restoration. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Operation, minimally invasive

Management of hangman’s fracture with percutaneous transpedicular screw fixation

This study describes a percutaneous technique for C2 transpedicular screw fixation and evaluates its safety and efficacy in the treatment of patients with hangman's fracture. Ten patients with hangman's fracture were treated by percutaneous C2 transpedicular screw fixation. There are six males and four females, who were, based on the classification of Levine and Edwards, sorted as follows: type I fracture, three cases; type II, five cases; type IIa, two cases. The causes of injury were road traffic accident in six patients and falling injury in four patients. Other associated lesions included rib fractures (7 patients), head injuries (4 patients), and fractures of extremities (6 patients). The new technique was performed successfully in all cases. The average operation time was 98 min (range 60-130 min) and the estimated blood loss was 25 ml (range 15-40 ml). No complications such as vascular or neural structures injuries were found intraoperatively. Postoperative CT scans demonstrated that 17 (85 %) of 20 screws were placed satisfactorily, and 3 (15 %) screws showed perforations of the pedicle wall (<2 mm). These patients were asymptomatic and no further intervention was required postoperatively. After 8-25 months follow-up (mean 15.3 months), solid fusion was demonstrated by computed tomography. All cases got well-sagittal alignment and no angulation or dislocation was found at the segment of C2-C3. There was no loss of fixation. Clinical examination showed a full range of motion in the neck in all patients. The fluoroscopically assisted percutaneous C2 transpedicular screw fixation method is a technically feasible and minimally invasive technique for hangman's fracture.

Minimally Invasive Multi-Level Posterior Lumbar Interbody Fusion Using a Percutaneously Inserted Spinal Fixation System : Technical Tips, Surgical Outcomes

There are technical limitations of multi-level posterior pedicle screw fixation performed by the percutaneous technique. The purpose of this study was to describe the surgical technique and outcome of minimally invasive multi-level posterior lumbar interbody fusion (PLIF) and to determine its efficacy. Forty-two patients who underwent mini-open PLIF using the percutaneous screw fixation system were studied. The mean age of the patients was 59.1 (range, 23 to 78 years). Two levels were involved in 32 cases and three levels in 10 cases. The clinical outcome was assessed using the visual analog scale (VAS) and Low Back Outcome Score (LBOS). Achievement of radiological fusion, intra-operative blood loss, the midline surgical scar and procedure related complications were also analyzed. The mean follow-up period was 25.3 months. The mean LBOS prior to surgery was 34.5, which was improved to 49.1 at the final follow up. The mean pain score (VAS) prior to surgery was 7.5 and it was decreased to 2.9 at the last follow up. The mean estimated blood loss was 238 mL (140-350) for the two level procedures and 387 mL (278-458) for three levels. The midline surgical scar was 6.27 cm for two levels and 8.25 cm for three level procedures. Complications included two cases of asymptomatic medial penetration of the pedicle border. However, there were no signs of neurological deterioration or fusion failure. Multi-level, minimally invasive PLIF can be performed effectively using the percutaneous transpedicular screw fixation system. It can be an alternative to the traditional open procedures.

Minimally invasive percutaneous transpedicular screw fixation: increased accuracy and reduced radiation exposure by means of a novel electromagnetic navigation system

BackgroundMinimally invasive percutaneous pedicle screw instrumentation methods may increase the need for intraoperative fluoroscopy, resulting in excessive radiation exposure for the patient, surgeon, and support staff. Electromagnetic field (EMF)-based navigation may aid more accurate placement of percutaneous pedicle screws while reducing fluoroscopic exposure. We compared the accuracy, time of insertion, and radiation exposure of EMF with traditional fluoroscopic percutaneous pedicle screw placement.Methods Minimally invasive pedicle screw placement in T8 to S1 pedicles of eight fresh-frozen human cadaveric torsos was guided with EMF or standard fluoroscopy. Set-up, insertion, and fluoroscopic times and radiation exposure and accuracy (measured with post-procedural computed tomography) were analyzed in each group.ResultsSixty-two pedicle screws were placed under fluoroscopic guidance and 60 under EMF guidance. Ideal trajectories were achieved more frequently with EMF over all segments (62.7% vs. 40%; p = 0.01). Greatest EMF accuracy was achieved in the lumbar spine, with significant improvements in both ideal trajectory and reduction of pedicle breaches over fluoroscopically guided placement (64.9% vs. 40%, p = 0.03, and 16.2% vs. 42.5%, p = 0.01, respectively). Fluoroscopy time was reduced 77% with the use of EMF (22 s vs. 5 s per level; p < 0.0001) over all spinal segments. Radiation exposure at the hand and body was reduced 60% (p = 0.058) and 32% (p = 0.073), respectively. Time for insertion did not vary between the two techniques.ConclusionsMinimally invasive pedicle screw placement with the aid of EMF image guidance reduces fluoroscopy time and increases placement accuracy when compared with traditional fluoroscopic guidance while adding no additional time to the procedure.

Image guided percutaneous trans-pedicular screw fixation of the thoracic spine. A clinical evaluation

We report our preliminary experience with a minimally invasive image guided percutaneous trans-pedicular fixation technique of the thoracic spine in patients with significant co-morbidity. This study aims to demonstrate the feasibility and efficacy of the presented operative technique as well as to detect potential drawbacks. A navigated percutaneous application of trans-pedicular screws was performed in 14 patients with radiological validated instability of the thoracic spine and significant medical co-morbidity. Due to poor bone quality, vertebroplasty of the affected levels had to be performed in nine patients. The levels involved were (T9-12) in ten patients, the middle (T5-8) in two patients and the upper thoracic (T1-4) segments in two others. VAS scores for local back pain were used to assess clinical outcome. A total of 56 screws were inserted. There was no additional morbidity associated with the procedure. Post-operative CT scans and plain X-rays were obtained in all patients. In 2 (3.5%) medial penetration of the pedicle border occurred without neurological sequelae for the patient. Reduction of VAS scores regarding back pain during the first post-operative week was noted. Follow up ranged between 6 months and 12 months. Navigated percutaneous trans-pedicular fixation of the thoracic spine is feasible and can be performed safely in patients where open surgery is of significant risk. Pre-operative planning is essential in order to avoid intra-operative complications with the instrumentation system.

Application of percutaneous transpedicular screw fixation in the treatment of thoracolumbar fractures

目的 探讨应用微创经皮椎弓根内固定术治疗胸腰椎骨折的疗效.方法 2000年3月～2004年5月,采用经皮椎弓根内固定术治疗单节段、不稳定胸腰椎骨折32例.其中T12 8例,L1 16例,L2 6例,L3 2例.患者全部使用丹历.枢法模公司生产的CDH椎弓根内固定系统.在骨折节段上、下相邻椎弓根皮肤处做4个1.5 cm长的纵形切口,透视下,钻入椎弓根螺钉,从一端切口纵形将固定棒置入肌纤维间隙内,初步固定钉棒,撑开复位并矫正屈曲畸形.并以同期32例采用传统后路切开复位椎弓根内固定技术治疗的类似患者作为对照,比较两组的疗效.结果 经皮组32例患者术后获24～52个月(平均36个月)随访.手术时间平均为42.06 min,手术出血量平均为83.69 mL,住院时间平均为11.75 d,术后恢复工作时间平均为12周,术后2年后凸Cobb角轻度丢失.与对照组比较,经皮组手术时间、住院时间明显缩短,出血量明显减少,术后恢复快.结论 经皮椎弓根内固定术治疗胸腰椎骨折,复位及内固定效果好,手术操作简单安全、创伤轻、痛苦小,患者康复快。