scholarly journals Instrumentation Removal following Minimally Invasive Posterior Percutaneous Pedicle Screw-Rod Stabilization (PercStab) of Thoracolumbar Fractures Is Not Always Required

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Neil Manson ◽  
Dana El-Mughayyar ◽  
Erin Bigney ◽  
Eden Richardson ◽  
Edward Abraham
Keyword(s):  
Patient Satisfaction ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Pedicle Screw ◽  
Rating Scales ◽  
Case Series ◽  
Leg Pain ◽  
Mild Pain ◽  
Open Stabilization ◽  
Percutaneous Pedicle Screw

Study Design. Clinical case series. Background. Percutaneous stabilization for spinal trauma confers less blood loss, reduces postoperative pain, and is less invasive than open stabilization and fusion. The current standard of care includes instrumentation removal. Objective. 1. Reporting patient outcomes following minimally invasive posterior percutaneous pedicle screw-rod stabilization (PercStab). 2. Evaluating the results of instrumentation retention. Methods. A prospective observational study of 32 consecutive patients receiving PercStab without direct decompression or fusion. Baseline data demographics were collected. Operative outcomes of interest were operative room (OR) time, blood loss, and length of hospital stay. Follow-up variables of interest included patient satisfaction, Numeric Rating Scales for Back and Leg (NRS-B/L) pain, Oswestry Disability Index (ODI), and return to work. Clinical outcome data (ODI and NRS-B/L) were collected at 3, 12, 24 months and continued at a 24-month interval up to a maximum of 8 years postoperatively. Results. 81.25% of patients (n = 26) retained their instrumentation and reported minimal disability, mild pain, and satisfaction with their surgery and returned to work (mean = 6 months). Six patients required instrumentation removal due to prominence of the instrumentation or screw loosening, causing discomfort/pain. Instrumentation removal patients reported moderate back and leg pain until removal occurred; after removal, they reported minimal disability and mild pain. Neither instrumentation removal nor retention resulted in complications or further surgical intervention. Conclusions. PercStab without instrumentation removal provided high patient satisfaction, mild pain, and minimal disability and relieved the patient from the burden of finances and resources allocation of a second surgery.

scholarly journals Minimally invasive guidewireless, navigated pedicle screw placement: a technical report and case series

2017 ◽  
Vol 43 (2) ◽  
pp. E9 ◽  
Author(s):  
Brandon W. Smith ◽  
Jacob R. Joseph ◽  
Michael Kirsch ◽  
Mary Oakley Strasser ◽  
Jacob Smith ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Kirschner Wire ◽  
Case Series ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Minimally Invasive Spinal Surgery ◽  
Screw Insertion ◽  
Percutaneous Pedicle Screw

OBJECTIVEPercutaneous pedicle screw insertion (PPSI) is a mainstay of minimally invasive spinal surgery. Traditionally, PPSI is a fluoroscopy-guided, multistep process involving traversing the pedicle with a Jamshidi needle, placement of a Kirschner wire (K-wire), placement of a soft-tissue dilator, pedicle tract tapping, and screw insertion over the K-wire. This study evaluates the accuracy and safety of PPSI with a simplified 2-step process using a navigated awl-tap followed by navigated screw insertion without use of a K-wire or fluoroscopy.METHODSPatients undergoing PPSI utilizing the K-wire–less technique were identified. Data were extracted from the electronic medical record. Complications associated with screw placement were recorded. Postoperative radiographs as well as CT were evaluated for accuracy of pedicle screw placement.RESULTSThirty-six patients (18 male and 18 female) were included. The patients’ mean age was 60.4 years (range 23.8–78.4 years), and their mean body mass index was 28.5 kg/m2 (range 20.8–40.1 kg/m2). A total of 238 pedicle screws were placed. A mean of 6.6 pedicle screws (range 4–14) were placed over a mean of 2.61 levels (range 1–7). No pedicle breaches were identified on review of postoperative radiographs. In a subgroup analysis of the 25 cases (69%) in which CT scans were performed, 173 screws were assessed; 170 (98.3%) were found to be completely within the pedicle, and 3 (1.7%) demonstrated medial breaches of less than 2 mm (Grade B). There were no complications related to PPSI in this cohort.CONCLUSIONSThis streamlined 2-step K-wire–less, navigated PPSI appears safe and accurate and avoids the need for radiation exposure to surgeon and staff.

scholarly journals Flexion-distraction injuries of the thoracolumbar spine: open fusion versus percutaneous pedicle screw fixation

2013 ◽  
Vol 35 (2) ◽  
pp. E2 ◽  
Author(s):  
Andrew J. Grossbach ◽  
Nader S. Dahdaleh ◽  
Taylor J. Abel ◽  
Gregory D. Woods ◽  
Brian J. Dlouhy ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Pedicle Screw ◽  
Operative Time ◽  
Spinal Injury ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Percutaneous Pedicle Screw ◽  
Percutaneous Pedicle Screw Fixation

Object Flexion-distraction injuries occur due to distractive forces causing disruption of the posterior and middle spinal columns. These fractures classically consist of a fracture line through the posterior bony elements; involvement of the posterior ligamentous complex is, however, common. Surgical treatment is often required for these unstable injuries to avoid neurological deterioration and posttraumatic kyphosis, and the surgery traditionally consists of an open posterior approach with instrumented fusion. Percutaneous pedicle screw fixation for these injuries, with the goal of minimal tissue disruption and preservation of normal anatomy while achieving adequate stabilization, has recently been reported in the literature, but to date, a direct comparative study comparing open and percutaneous fixation has not been reported. The authors report their experience treating these fractures with both techniques and review the available literature. Methods Patients with flexion-distraction injury who were treated between May 2003 and March 2013 were prospectively followed. American Spinal Injury Association scores and degree of kyphotic angulation were recorded at admission, discharge, and follow-up. Data regarding intraoperative blood loss and operative time were obtained from a chart review. Patients treated with open versus minimally invasive procedures were compared. Results The authors identified 39 patients who suffered flexion-distraction injuries and were treated at their institution during the specified period; one of these patients declined surgery. All had injury to the posterior ligamentous complex. Open surgical procedures with pedicle screw fixation and posterolateral fusion were performed in 27 patients, while 11 patients underwent minimally invasive pedicle screw placement. Overall, there was improvement in kyphotic angulation at the time of discharge as well as most recent follow-up in both the open surgery and minimally invasive surgery (MIS) groups. The authors found no significant difference in American Spinal Injury Association score or the degree of kyphotic angulation between the MIS and open surgery groups. There was a trend toward shorter operative time for the MIS group, and patients who underwent minimally invasive procedures had significantly less blood loss. Conclusions Minimally invasive percutaneous pedicle screw fixation appears to have similar efficacy in the treatment of flexion-distraction injuries and it allows for reduced blood loss and tissue damage compared with open surgical techniques. Therefore it should be considered as an option for the treatment of this type of injury.

scholarly journals Microsurgical unilateral laminotomy for bilateral decompression of degenerative lumbar canal stenosis: a comparative study

2019 ◽  
Vol 55 (1) ◽  
Author(s):  
Mohamed I. Refaat ◽  
Amr K. Elsamman ◽  
Adham Rabea ◽  
Mohamed I. A. Hewaidy
Keyword(s):  
Patient Satisfaction ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Invasive Technique ◽  
Decompression Surgery ◽  
Microsurgical Decompression ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract Background The quest for better patient outcomes is driving to the development of minimally invasive spine surgical techniques. There are several evidences on the use of microsurgical decompression surgery for degenerative lumbar spine stenosis; however, few of these studies compared their outcomes with the traditional laminectomy technique. Objectives The aim of our study was to compare outcomes following microsurgical decompression via unilateral laminotomy for bilateral decompression (ULBD) of the spinal canal to the standard open laminectomy for cases with lumbar spinal stenosis. Subjects and methods Cases were divided in two groups. Group (A) cases were operated by conventional full laminectomy; Group (B) cases were operated by (ULBD) technique. Results from both groups were compared regarding duration of surgery, blood loss, perioperative complication, and postoperative outcome and patient satisfaction. Results There was no statistically significant difference between both groups regarding the improvement of visual pain analogue, while improvement of neurogenic claudication outcome score was significant in group (B) than group (A). Seventy-three percent of group (A) cases and 80% of group (B) stated that surgery met their expectations and were satisfied from the outcome. Conclusion Comparing ULBD with traditional laminectomy showed the efficacy of the minimally invasive technique in obtaining good surgical outcome and patient satisfaction. There was no statistically significant difference between both groups regarding the occurrence of complications The ULBD technique was found to respect the posterior spinal integrity and musculature, accompanied with less blood loss, shorter hospital stays, and shorter recovery periods than the open laminectomy technique.

scholarly journals Radiographic Accuracy of Percutaneous Pedicle Screw Placement in Fluoroscopic- Versus CT Navigation-Guided Lumbar Spine Instrumentation

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Guang-Ting Cong ◽  
Avani Vaishnav ◽  
Joseph Barbera ◽  
Hiroshi Kumagai ◽  
James Dowdell ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Intraoperative Computed Tomography ◽  
Percutaneous Pedicle Screw ◽  
Spine Instrumentation ◽  
Surgical Methods

Abstract INTRODUCTION Posterior spinal instrumentation for fusion using intraoperative computed tomography (CT) navigation is gaining traction as an alternative to the conventional two-dimensional fluoroscopic-guided approach to percutaneous pedicle screw placement. However, few studies to date have directly compared outcomes of these 2 minimally invasive instrumentation methods. METHODS A consecutive cohort of patients undergoing primary percutaneous posterior lumbar spine instrumentation for spine fusion was retrospectively reviewed. Revision surgeries or cases converted to open were excluded. Accuracy of screw placement was assessed using a postoperative CT scan with blinding to the surgical methods used. The Gertzbein-Robbins classification was used to grade cortical breach: Grade 0 (<0 mm cortical breach), Grade I (<2 mm), Grade II (2-4 mm), Grade III (4-6 mm), and Grade IV (>6 mm). RESULTS CT navigation was found to significantly improve accuracy of screw placement (P < .022). There was significantly more facet violation of the unfused level in the fluoroscopy group vs the CT group (9% vs 0.5%; P < .0001). There was also a higher proportion of poor screw placement in the fluoroscopy group (10.1% vs 3.6%). No statistical difference was found in the rate of tip breach, inferomedial breach, or lateral breach. Regression analysis showed that fluoroscopy had twice the odds of incurring poor screw placement as compared to CT navigation. CONCLUSION This radiographic study comparing screw placement in minimally invasive fluoroscopy- vs CT navigation-guided lumbar spine instrumentation provides evidence that CT navigation significantly improves accuracy of screw placement, especially in optimizing the screw trajectory so as to avoid facet violation. Long-term follow-up studies should be performed to ascertain whether this difference can contribute to an improvement in clinical outcomes.

Minimally Invasive Single-Position Lateral Interbody Fusion With Robotic Bilateral Percutaneous Pedicle Screw Fixation: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (4) ◽  
pp. E121-E121 ◽  
Author(s):  
Corey T Walker ◽  
Jakub Godzik ◽  
David S Xu ◽  
Nicholas Theodore ◽  
Juan S Uribe ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Screw Placement ◽  
Lateral Interbody Fusion ◽  
Percutaneous Pedicle Screw ◽  
Percutaneous Pedicle Screw Fixation ◽  
Lateral Interbody

Abstract Lateral interbody fusion has distinct advantages over traditional posterior approaches. When adjunctive percutaneous pedicle screw fixation is required, placement from the lateral decubitus position theoretically increases safety and improves operative efficiency by obviating the need for repositioning. However, safe cannulation of the contralateral, down-side pedicles remains technically challenging and often prohibitive. In this video, we present the case of a 59-yr-old man with refractory back pain and bilateral lower extremity radiculopathy that was worse on the left than right side. The patient provided written informed consent before undergoing treatment. We performed minimally invasive single-position lateral interbody fusion with robotic (ExcelsiusGPS, Globus Medical Inc, Audubon, Pennsylvania) bilateral percutaneous pedicle screw fixation for the treatment of asymmetric disc degeneration, dynamic instability, and left paracentral disc herniation with corresponding stenosis at the L3-4 level. A left-sided minimally invasive transpsoas lateral interbody graft was placed with fluoroscopic guidance. Without changing the position of the patient or breaking the sterile field, an intraoperative cone-beam computed tomography image was obtained for navigational screw placement with stereotactic trackers in the iliac spine. Screw trajectories were planned using the robotic navigation software and were placed percutaneously in the bilateral L3 and L4 pedicles using the robotic arm. Concomitant lateral fluoroscopy may be used if desired to ensure the fidelity of the robotic guidance. The patient recovered well postoperatively and was discharged home within 36 h, without complication. Single-position lateral interbody fusion and percutaneous pedicle screw fixation can be accomplished using robotic-assisted navigation and pedicle screw placement. Used with permission from Barrow Neurological Institute.

Minimally Invasive Transforaminal Lumbar Interbody Debridement and Fusion with Percutaneous Pedicle Screw Instrumentation for Spondylodiscitis

2019 ◽  
Vol 128 ◽  
pp. e744-e751 ◽  
Author(s):  
Michael Jian-Wen Chen ◽  
Chi-Chien Niu ◽  
Ming-Kai Hsieh ◽  
An-Jhih Luo ◽  
Tsai-Sheng Fu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Pedicle Screw Instrumentation ◽  
Percutaneous Pedicle Screw
Sign in / Sign up

Export Citation Format

Share Document