The percutaneous insertion technique requires surgical skill and experience. However, there have been few clinical reports evaluating the accuracy of minimally invasive pedicle screw placement using the conventional fluoroscopy method. The purpose of this study was to evaluate the accuracy of percutaneous pedicle screw placement in the treatment of thoracic and lumbar spine fractures using two-plane conventional fluoroscopy.
A prospective clinical trial was performed. A total of 502 percutaneous pedicle screws in 111 patients, all inserted with the assistance of conventional fluoroscopy, were evaluated. The safety and accuracy of pedicle screw placement were based on the evaluation of postoperative axial 3-mm slice computed tomography scans using the scoring system described by Zdichavsky et al. [Eur J Trauma 30:234–240, 2004; Eur J Trauma 30:241–247, 2004].
427/502 pedicle screws (85 %) were classified as good and excellent concerning the best possible screw length and 494/502 (98 %) were found to have good or excellent position. One screw had to be revised due to medial position with a neurological deficit.
This study demonstrates the feasibility of placing percutaneous posterior thoracolumbar pedicle screws with the assistance of conventional fluoroscopy. Minimally invasive transpedicular instrumentation is an accurate, reliable and safe method to treat a variety of spinal disorders, including thoracic and lumbar spine fractures.
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Bednar DA, Raducan V (1996) External spinal skeletal fixation in the management of back pain. Clin Orthop 322:131–145
Belmont PJ, Klemme WR, Dhawan A, Polly DW Jr (2001) In vivo accuracy of thoracic pedicle screws. Spine 26:2340–2346
Blattert TR, Katscher S, Josten C (2011) Percutaneous techniques in the thoracic and lumbar spine. Unfallchirurg 114(1):17–25
Esses SI, Botsford DJ, Kostuik JP (1989) The role of external spinal skeletal fixation in the assessment of low-back disorders. Spine 14:594–601
Fan S, Hu Z, Zhao F, Zhao X, Huang Y, Fang X (2010) Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. Eur Spine J 19(2):316–324
Fan SW, Hu ZJ, Fang XQ, Zhao FD, Huang Y, Yu HJ (2010) Comparison of paraspinal muscle injury in one-level lumbar posterior inter-body fusion: modified minimally invasive and traditional open approaches. Orthop Surg 2(3):194–200
Gertzbein SD, Robbins SE (1990) Accuracy of pedicular screw placement in vivo. Spine 15:11–14
Grass R, Biewener A, Dickopf A (2006) Perkutane dorsale versus offene Instrumentation bei Fraktu-ren des thorakolumbalen Über-gangs: Eine vergleichende prospective Untersuchung. Unfallchirurg 109:297–305
Hirano T, Hasegawa K, Takahashi HE, Uchiyama S, Hara T, Washio T, Sugiura T, Yokaichiya M, Ikeda M (1997) Structural characteristics of the pedicle and its role in screw stability. Spine 22:2504–2509
Holly LT, Schwender JD, Rouben DP, Foley KT (2006) Minimally invasive transforaminal lumbar interbody fusion: indications, technique and complications. Neurosurg Focus 20:1–5
Jeanneret B, Jovanovic M, Magerl F (1994) Percutaneous diagnostic stabilization for low back pain: correlation with results after fusion operations. Clin Orthop 304:130–138
Liljenqvist UR, Halm HF, Link TM (1997) Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine 22:2239–2245
Lyon DW, Hall DJ, Mulholland RC, Webb JK (1993) The role of external fixation as a predictor of fusion success. In: Ono K, Takemitsu Y, Yonenobu K (eds) Lumbar fusion and stabilization. Springer, Tokyo, pp 25–34
Magerl F (1980) Verletzungen der Burst- und Lendenwirbelsäule. Langenbecks Arch Chir 352:428–433
Magerl F (1984) Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop 189:125–141
Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3(4):184–201
Nakashima H, Sato K, Ando T, Inoh H, Nakamura H (2009) Comparison of the percutaneous screw placement precision of isocentric C-arm 3-dimensional fluoroscopy-navigated pedicle screw implantation and conventional fluoroscopy method with minimally invasive surgery. J Spinal Disord Tech 22(7):468–472
Olerud S, Sjöström L, Karlström G, Hamberg M (1986) Spontaneous effect of increased stability of the lower lumbar spine in cases of severe chronic back pain: the answer of an external transpeduncular fixation test. Clin Orthop 203:67–74
Park Y, Ha JW (2007) Comparison of one level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach. Spine 32:537–543
Polly DW Jr, Potter BK, Kuklo T, Young S, Johnson C, Klemme WR (2004) Volumetric spinal canal intrusion: a comparison between thoracic pedicle screws and thoracic hooks. Spine 29(1):63–69
Prokop A, Löhlein F, Chmielnicki M, Volbracht J (2009) Minimally invasive percutaneous instrumentation for spine fractures. Unfallchirurg 112:621–628
Rodriguez-Vela J, Lobo-Escolar A, Joven-Aliaga E, Herrera A, Vicente J, Sunen E, Loste A, Tabuenca A (2009) Perioperative and short-term advantages of mini-open approach for lumbar spinal fusion. Eur Spine J 18(8):1194–1201
Soini J, Seitsalo S (1993) The external fixation test of the lumbar spine: 30 complications in 25 of 100 consecutive patients. Acta Orthop Scand 64:147–149
Tiusanen H, Seitsalo S, Östermann K, Soini J (1996) The role of external transpedicular fixation in anterior interbody lumbar fusion. J Spinal Disord 9:433–438
Weinstein JN, Rydevik BL, Rausching WR (1992) Anatomical and technical considerations of pedicle screw fixation. Clin Orthop 284:34–46
Youkilis AS, Quint DJ, McGillicuddy JE, Papadopoulos SM (2001) Stereotactic navigation for placement of pedicle screws in the thoracic spine. Neurosurgery 48:771–779
Zdichavsky M, Blauth M, Knop C, Graessner M, Herrmann H, Krettek C, Bastian L (2004) Accuracy of pedicle screw placement in thoracic spine fractures. Part I: inter- and intra-observer reliability of the scoring system. Eur J Trauma 30:234–240
Zdichavsky M, Blauth M, Knop C, Lotz J, Krettek C, Bastian L (2004) Accuracy of pedicle screw placement in thoracic spine fractures. Part II: a retrospective analysis of 278 pedicle screws using computed tomographic scans. Eur J Trauma 30:241–247
Zindrick MR, Wiltse LL, Widell EH, Thomas JC, Holland WR, Field BT, Spencer CW (1986) A biomechanical study of intrapeduncular screw fixation in the lumbosacral spine. Clin Orthop Relat Res 203:99–112
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Heintel, T.M., Berglehner, A. & Meffert, R. Accuracy of percutaneous pedicle screws for thoracic and lumbar spine fractures: a prospective trial. Eur Spine J 22, 495–502 (2013). https://doi.org/10.1007/s00586-012-2476-8
- Thoracolumbar spine fractures
- Pedicle screw
- Percutaneous technique
- Minimally invasive spine surgery
- Transpedicular instrumentation