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Percutaneous Pedicle Screws

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Minimally Invasive Spine Surgery

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Abstract

Minimally invasive techniques in pedicle screw insertion provide an additional option to a spine surgeon’s armamentarium in dealing with various spine pathologies. It can be applied to practically any surgical setting where conventional open technique is indicated. The most apparent advantage of percutaneous pedicle screw insertion relates to reduced paraspinal muscle damage. Studies have shown that this decreased approach-related morbidity results in decreased operative blood loss, reduced postoperative narcotic use, and greater preservation of trunk extension strength.

Because direct visualization of anatomic landmarks is sacrificed, intraoperative imaging is necessary to facilitate safe pedicle screw placement. Two common methods of percutaneous pedicle screw insertion are discussed in this chapter. The first is with real-time two-dimensional (2-D) fluoroscopic imaging. The second is with three-dimensional (3-D) image-guided navigation which employs virtual images taken with an intraoperative CT scanner. Accuracy rates with either method have been demonstrated to be similar or improved compared to open technique.

The benefit of improved imaging technology is associated with increased radiation exposure risk. This can be minimized by wearing protective garments, observing safe distance from the beam source, and limiting or eliminating unnecessary exposure.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA

    Jonathan N. Sembrano, Sharon C. Yson & David W. Polly Jr.

Authors
  1. Jonathan N. Sembrano
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  2. Sharon C. Yson
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  3. David W. Polly Jr.
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Corresponding author

Correspondence to Jonathan N. Sembrano .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Frank M. Phillips

  2. Texas Back Institute Texas Health Presbyterian Hospital Plano Scoliosis and Spine Tumor Center, Plano, TX, USA

    Isador H. Lieberman

  3. Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA

    David W. Polly Jr.

  4. Department of Neurological Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL, USA

    Michael Y. Wang

Appendices

Quiz Questions

True/False

  1. 1.

    In the process of obtaining true AP and lateral images, it is advisable to rotate (i.e., “rainbow”) the C-arm and leaving the bed parallel to the floor.

  2. 2.

    The use of 3-D imaging navigation potentially reduces surgical team radiation exposure, since the surgical team can step out of the operating room or hide behind lead shields during 3-D image acquisition.

Answers

  1. 1.

    False

  2. 2.

    True

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Sembrano, J.N., Yson, S.C., Polly, D.W. (2019). Percutaneous Pedicle Screws. In: Phillips, F., Lieberman, I., Polly Jr., D., Wang, M. (eds) Minimally Invasive Spine Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-19007-1_20

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  • DOI: https://doi.org/10.1007/978-3-030-19007-1_20

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-19006-4

  • Online ISBN: 978-3-030-19007-1

  • eBook Packages: MedicineMedicine (R0)

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