Percutaneous pedicle screw implantation for refractory low back pain: from manual 2D to fully robotic intraoperative 2D/3D fluoroscopy

The utilization of pedicle screw fixation as an adjunct to posterolateral lumbar fusion (PLF) has become routine, but demonstration of a definitive benefit remains problematic. The medical evidence indicates that the addition of pedicle screw fixation to PLF increases fusion rates when assessed with dynamic radiographs. More recent evidence, since publication of the 2005 Lumbar Fusion Guidelines, suggests a stronger association between radiographic fusion and clinical outcome, although, even now, no clear correlation has been demonstrated. Although several reports suggest that clinical outcomes are improved with the addition of pedicle screw fixation, there are conflicting findings from similarly classified evidence. Furthermore, the largest contemporary, randomized, controlled study on this topic failed to demonstrate a significant clinical benefit with the use of pedicle screw fixation in patients undergoing PLF for chronic low-back pain. This absence of proof should not, however, be interpreted as proof of absence. Several limitations continue to compromise these investigations. For example, in the majority of studies the sample size is insufficient to detect small increments in clinical outcome that may be observed with pedicle screw fixation. Therefore, no definitive statement regarding the efficacy of pedicle screw fixation as a means to improve functional outcomes in patients undergoing PLF for chronic low-back pain can be made. There appears to be consistent evidence suggesting that pedicle screw fixation increases the costs and complication rate of PLF. High-risk patients, including (but not limited to) patients who smoke, patients who are undergoing revision surgery, or patients who suffer from medical conditions that may compromise fusion potential, may appreciate a greater benefit with supplemental pedicle screw fixation. It is recommended, therefore, that the use of pedicle screw fixation as a supplement to PLF be reserved for those patients in whom there is an increased risk of nonunion when treated with only PLF.

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Pedicle Screw-Based Posterior Dynamic Stabilization: Literature Review

Advances in Orthopedics ◽

10.1155/2012/424268 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 20

Author(s):

Dilip K. Sengupta ◽

Harry N. Herkowitz

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Surgical Treatment ◽

Pedicle Screw ◽

Clinical Evidence ◽

Dynamic Stabilization ◽

Low Back ◽

Design Rationale ◽

Clinical Instability ◽

Posterior Dynamic Stabilization

Posterior dynamic stabilization (PDS) indicates motion preservation devices that are aimed for surgical treatment of activity related mechanical low back pain. A large number of such devices have been introduced during the last 2 decades, without biomechanical design rationale, or clinical evidence of efficacy to address back pain. Implant failure is the commonest complication, which has resulted in withdrawal of some of the PDS devices from the market. In this paper the authors presented the current understanding of clinical instability of lumbar motions segment, proposed a classification, and described the clinical experience of the pedicle screw-based posterior dynamic stabilization devices.

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Full Percutaneous Lumbar Interbody Fusion: Technical Note

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0037-1604360 ◽

2017 ◽

Vol 78 (06) ◽

pp. 601-606 ◽

Cited By ~ 3

Author(s):

Mitsuto Taguchi ◽

Shu Nakamura

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pedicle Screw ◽

Interbody Fusion ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Low Back ◽

Lumbar Interbody Fusion ◽

Less Invasive ◽

Disk Degeneration

Introduction Although lumbar interbody fusion is effective for low back pain caused by severe disk degeneration, it is a highly invasive procedure. Less invasive procedures such as transforaminal lumbar interbody fusion (TLIF) and lumbar lateral interbody fusion have become available; however, there is still scope for improvement. We performed full percutaneous endoscopic lumbar interbody fusion (PELIF), a technique designed as a safe and less invasive percutaneous fusion. Method and Subjects Our technique is indicated for patients with chronic low back pain in whom conservative treatment was not effective, thinning of the intervertebral disk was prominent, and temporary pain relief was achieved with a disk block. In the operation, percutaneous endoscopic diskectomy was performed with a 7.5-mm sheath inserted through a small incision, and a cage was inserted percutaneously using an L-shaped retractor. Instead of pedicle screw fixation, hybrid facet screw fixation was performed. Low back pain was improved, and bone union was confirmed on radiography. This technique was used in six patients, and no surgery-related complications occurred. Discussion The L-shaped retractor used in this series can protect the exiting nerve by inserting it into the sheath, then removing the sheath and placing the rounded corner of the retractor on the lateral cranial side. This technique is safe with no other associated risks. Cages larger than the sheath can be inserted, and commercially available cages for TLIF are applicable. Hybrid facet screw fixation can overcome the problems associated with both conventional transfacet pedicle screw fixation and translaminar facet screw fixation by combining these two procedures. Conclusion PELIF is an easy, safe, and fully percutaneous technique with very low invasiveness that uses an L-shaped retractor and hybrid facet screw fixation. This procedure can be a treatment option for patients with severe low back pain related to disk degeneration.

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Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 12: pedicle screw fixation as an adjunct to posterolateral fusion for low-back pain

Journal of Neurosurgery Spine ◽

10.3171/spi.2005.2.6.0700 ◽

2005 ◽

Vol 2 (6) ◽

pp. 700-706 ◽

Cited By ~ 26

Author(s):

Daniel K. Resnick ◽

Tanvir F. Choudhri ◽

Andrew T. Dailey ◽

Michael W. Groff ◽

Larry Khoo ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Degenerative Disease ◽

Posterolateral Fusion ◽

Low Back

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Multilevel Direct Repair Surgery for Three-Level Lumbar Spondylolysis

Case Reports in Orthopedics ◽

10.1155/2013/472968 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Tetsu Arai ◽

Koichi Sairyo ◽

Isao Shibuya ◽

Ko Kato ◽

Akira Dezawa

Keyword(s):

Computed Tomography ◽

Low Back Pain ◽

Back Pain ◽

Pedicle Screw ◽

Bony Union ◽

Low Back ◽

Screw Head ◽

Direct Repair ◽

Lumbar Spondylolysis ◽

Rod System

A 45-year-old man presented to our clinic requesting evaluation for surgical treatment of chronic low back pain of more than 20 years duration. He was diagnosed with 3-level lumbar spondylolysis at L3–5. Direct repair using the pedicle screw and hook-rod system was conducted for all three levels. After the surgery, his low back pain completely disappeared. Six months later, he felt discomfort and heard a metallic sound as he twisted his trunk. Computed tomography and radiography indicated that the hook head for L3 and the screw head for L4 were interfering with each other, causing the sound. We confirmed bony union at L3 and removed the L3 system. Surgeons should be aware of such complications if direct repair using a pedicle screw and hook-rod system is conducted for multilevel spondylolysis.

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Multiple-level lumbar spondylolysis and spondylolisthesis

Journal of Neurosurgery Spine ◽

10.3171/2014.10.spine14415 ◽

2015 ◽

Vol 22 (3) ◽

pp. 283-287 ◽

Cited By ~ 6

Author(s):

Xinyu Liu ◽

Lianlei Wang ◽

Suomao Yuan ◽

Yonghao Tian ◽

Yanping Zheng ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pedicle Screw ◽

Interbody Fusion ◽

Japanese Orthopaedic Association ◽

Pedicle Screw Fixation ◽

Low Back ◽

Multiple Level ◽

Lumbar Spondylolysis ◽

Pars Interarticularis

OBJECT Lumbar spondylolysis and isthmic spondylolisthesis occur most commonly at only one spinal level. The authors report on 13 cases of lumbar spondylolysis with spondylolisthesis at multiple levels. METHODS During July 2007–March 2012, multiple-level spondylolysis associated with spondylolisthesis was diagnosed in 13 patients (10 male, 3 female) at Qilu Hospital of Shandong University. The mean patient age was 43.5 ± 14.6 years. The duration of low-back pain was 11.7 ± 5.1 months. Spondylolysis occurred at L-2 in 2 patients, L-3 in 4 patients, L-4 in all patients, and L-5 in 5 patients. Spondylolysis occurred at 3 spinal levels in 3 patients and at 2 levels in 10 patients. All patients had spondylolisthesis at 1 or 2 levels. Japanese Orthopaedic Association and visual analog scale scores were used to evaluate preoperative and postoperative neurological function and low-back pain. All patients underwent pedicle screw fixation and interbody fusion or direct pars interarticularis repair. RESULTS Both low-back pain scores improved significantly after surgery (p < 0.05). Postoperative radiographs or CT scans showed satisfactory interbody fusion or pars interarticularis healing. No breakage, dislodging, or loosening of the pedicle screw hardware was observed for any patient. CONCLUSIONS Multiple-level lumbar spondylolysis and spondylolisthesis occurred more often in men. Most multiplelevel lumbar spondylolysis occurred at 2 spinal levels and was associated with sports, trauma, or heavy labor. Multiplelevel lumbar spondylolysis occurred mostly at L3–5; associated spondylolisthesis usually occurred at L-4 and L-5, mostly at L-4. The treatment principle was the same as that for single-level spondylolisthesis.

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Pedicle Screw-Rod Fixation for Treatment of Lumbosacral Intervertebral Disc Degeneration in Dogs with Low Back Pain

Global Spine Journal ◽

10.1055/s-0034-1376719 ◽

2014 ◽

Vol 4 (1_suppl) ◽

pp. s-0034-1376719-s-0034-1376719

Author(s):

B. Meij ◽

A. Tellegen ◽

N. Willems ◽

M. Tryfonidou

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Intervertebral Disc ◽

Pedicle Screw ◽

Disc Degeneration ◽

Intervertebral Disc Degeneration ◽

Low Back

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Transforaminal Lumbar Interbody Fusion: Technique, Complications, and Early Results

Neurosurgery ◽

10.1097/00006123-200103000-00022 ◽

2001 ◽

Vol 48 (3) ◽

pp. 569-575 ◽

Cited By ~ 170

Author(s):

William S. Rosenberg ◽

Praveen V. Mummaneni

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pedicle Screw ◽

Lumbar Lordosis ◽

Interbody Fusion ◽

Pedicle Screws ◽

Transforaminal Lumbar Interbody Fusion ◽

Brachial Plexopathy ◽

Low Back ◽

Lumbar Interbody Fusion

Abstract OBJECTIVE To demonstrate the safety, surgical efficacy, and advantages of the transforaminal approach for lumbar interbody fusion when combined with pedicle screw fixation. METHODS We retrospectively reviewed the records of 22 patients (age range, 34–63 yr; mean, 49 yr) with Grade I or II spondylolisthesis who underwent transforaminal lumbar interbody fusion. Nineteen patients presented with low back pain and associated radiculopathy, and three presented with low back pain only. Transforaminal lumbar interbody fusion was performed at L4-L5 in 8 patients, L5-S1 in 11 patients, L3-L4 and L4-L5 in 2 patients, and L4-L5 and L5-S1 in 1 patient. Periodic follow-up took place 1 to 12 months after surgery (mean, 5.3 mo). Decompression is performed according to clinical circumstances. Pedicle screws are placed, and a discectomy is carried out. The cartilaginous endplates are removed. The interspace is gradually distracted, resulting in lost disc height being regained, and interbody fusion cages are positioned. The pedicle screw-and-rod construct is then compressed, restoring lumbar lordosis. RESULTS Low back pain completely resolved in 16 patients, moderate relief from pain was achieved in 5 patients, and the pain was unchanged in one patient. Nonneurological complications included intraoperative durotomy in one patient and postoperative wound infection in two. In one patient, postoperative mild L5 motor paresis resolved. One patient had a temporary brachial plexopathy due to intraoperative positioning, and one patient had peripheral polyneuropathy secondary to prolonged intraoperative blood pressure cuff inflation. CONCLUSION Transforaminal lumbar interbody fusion is a safe and effective method for achieving circumferential spinal fusion via a single-stage procedure. This procedure is particularly useful in restoring disc space height and lumbar lordosis.

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Management of Occult Spondylolisthesis in a Case of Low Back Pain

Surgical Case Reports ◽

10.31487/j.scr.2020.09.19 ◽

2020 ◽

pp. 1-3

Author(s):

Md. Moshiur Rahman ◽

S.I.M Khairun Nabi Khan ◽

Robert Ahmed Khan ◽

Luis Rafael Moscote-Salazar ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pedicle Screw ◽

Full Range ◽

Low Back ◽

Radiologic Finding ◽

Gold Standard Method ◽

Lower Back ◽

Lumbar Spinal ◽

Prolapsed Disc

Spondylolisthesis is a condition of the spine that causes lower back pain. It is a vertebra slippage that occurs at the base of the spine, in most instances. We report a case of occult spondylolisthesis of a patient with grade 1 spondylolisthesis (L4 over L5). We presented the radiologic finding, diagnosis, and treatment here. A 45-year-old female was presented with the complaints of low back pain with sciatica for 4 years. The radiologic finding showed that she had dysaesthesia on both L5 dermatome and MRI of LS Spine revealed prolapsed disc at L4/5. The patient underwent decompression, stabilization via pedicle screw at L4 and L5 with fusion at L4/5 and after constant follow-ups, she was symptom-free with a full range of motion of the spine. Posterior fusion with instrumentation of the pedicle screw is commonly considered the gold standard method of lumbar spinal fusion. Non-surgical treatment is effective in relieving low back pain of the patient in most cases however, symptomatic patients need to be treated with the surgical method.

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