• Federico Landriel, Alfredo Guiroy, Alejandro Morales Ciancio, Nestor Taboada, Cristiano Menezes, Alberto Gotfryd, Sebastián Kornfeld, Santiago Hem, and AO Spine Latin America Minimally Invasive Study Group.
• Neurosurgical Department, Spine Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. Electronic address: federico.landriel@hospitalitaliano.org.ar.
• World Neurosurg. 2021 May 1; 149: 15-25.

BackgroundTwo-dimensional fluoroscopy-guided percutaneous pedicle screw placement is currently the most widely applied instrumentation for minimally invasive treatment of spinal injuries requiring stabilization. Although this technique has advantages over open instrumentation, it also presents new challenges and specific complications. The objective of this study was to provide recommendations developed from the experience of several spinal surgeons at different minimally invasive spine surgery reference centers to solve specific problems and prevent complications during the learning curve of this technique.MethodsAn AO Spine Latin America minimally invasive spine surgery study group analyzed the most frequent complications and challenges occurring during the placement of >14,000 two-dimensional fluoroscopy-guided percutaneous pedicle screws at different centers over 15 years. Twenty tips considered most relevant to performing this technique, excluding problems directly related to specific brands of instruments, were presented.ResultsThe 20 tips included the following: (1) positioning; (2) clean and painless; (3) fewer x-rays; (4) check the clock; (5) beveled tip; (6) transverse-rib-pedicle; (7) double Jamshidi; (8) hammer the Kirschner wire; (9) bent tip; (10) too loose, too tight; (11) new trajectory; (12) manual control; (13) start over; (14) Kirschner wire first; (15) adhesive drape control; (16) bend the rod; (17) lower rods; (18) freehand inner; (19) posterior fusion; (20) revision.ConclusionsImplementation of these tips might improve performance of this technique and reduce the complications related to percutaneous pedicle screw placement.Copyright © 2021 Elsevier Inc. All rights reserved.

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