Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results

Journal of Neurosurgery: Spine - Tập 97 Số 1 - Trang 7-12 - 2002
Kevin T. Foley1, Sanjay Gupta
1Image-Guided Surgery Research Center, James Murphy Clinic, Memphis, Tennessee 38104, USA.

Tóm tắt

Object. Standard techniques for pedicle screw fixation of the lumbar spine involve open exposures and extensive muscle dissection. The purpose of this study was to report the initial clinical experience with a novel device for percutaneous posterior fixation of the lumbar spine.

Methods. An existing multiaxial lumbar pedicle screw system was modified to allow screws to be placed percutaneously by using an extension sleeve that permits remote manipulation of the polyaxial screw heads and remote engagement of the screw-locking mechanism. A unique rod-insertion device was developed that linked to the screw extension sleeves, allowing for a precut and -contoured rod to be placed through a small stab wound. Because the insertion device relies on the geometrical constraint of the rod pathway through the screw heads, minimal manipulation is required to place the rods in a standard submuscular position, there is essentially no muscle dissection, and the need for direct visual feedback is avoided. Twelve patients (six men and six women) who ranged in age from 23 to 68 years underwent pedicle screw fixation in which the rod-insertion device was used. Spondylolisthesis was present in 10 patients and osseous nonunion of a prior interbody fusion was present in two. All patients underwent successful percutaneous fixation. Ten patients underwent single-level fusions (six at L5—S1, three at L4–5, and one at L2–3), and two underwent two-level fusions (one from L3–5 and the other from L4—S1). The follow-up period ranged from 10 to 19 months (mean 13.8 months).

Conclusions. Although percutaneous lumbar pedicle screw placement has been described previously, longitudinal connector (rod or plate) insertion has been more problematic. The device used in this study allows for straightforward placement of lumbar pedicle screws and rods through percutaneous stab wounds. Paraspinous tissue trauma is minimized without compromising the quality of spinal fixation. Preliminary experience involving the use of this device has been promising.

Từ khóa


Tài liệu tham khảo

Foley, 2000, Virtual fluoroscopy., 10, 77, 10.1016/S1048-6666(00)80046-4

Foley, 2001, Virtual fluoroscopy: computer-assisted fluoroscopic navigation., 26, 347, 10.1097/00007632-200102150-00009

Foley, 1997, Microendoscopic discectomy., 3, 301

Gaines, 2000, The use of pedicle-screw internal fixation for the operative treatment of spinal disorders., 82, 1458, 10.2106/00004623-200010000-00013

Lowery, 2000, Posterior percutaneous spine instrumentation., 9, S126, 10.1007/PL00008318

Macnab, 1971, Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients., 53, 891, 10.2106/00004623-197153050-00004

Magerl, 1982, External skeletal fixation of the lower thoracic and the lumbar spine, 353

Mathews, 1995, Endoscopy assisted percutaneous anterior interbody fusion with subcutaneous suprafascial internal fixation: evolution, techniques and surgical considerations., 3, 496

Rampersaud, 2000, Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion., 25, 2637, 10.1097/00007632-200010150-00016

Schlenzka, 2000, Computer-assisted spine surgery., 9, S57, 10.1007/PL00010023

Slomczykowski, 1999, Radiation dose for pedicle screw insertion. Fluoroscopic versus computer-assisted surgery., 24, 975, 10.1097/00007632-199905150-00009

Thomsen, 1997, 1997 Volvo Award winner in clinical studies. The effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral lumbar spinal fusion: a prospective, randomized clinical study., 22, 2813, 10.1097/00007632-199712150-00004

Wiesner, 1999, Anatomic evaluation of two different techniques for the percutaneous insertion of pedicle screws in the lumbar spine., 24, 1599, 10.1097/00007632-199908010-00015

Yuan, 1994, A historical cohort study of pedicle screw fixation in thoracic, lumbar, and sacral spinal fusions., 19, 2279S, 10.1097/00007632-199410151-00005

Zucherman, 1995, Instrumented laparoscopic spinal fusion. Preliminary results., 20, 2029, 10.1097/00007632-199509150-00015

Thông tin
Thông tin xuất bản

Journal of Neurosurgery: Spine

Tập 97 Số 1

7-12

Thông tin tác giả