• Fon-Yih Tsuang, Chia-Hsien Chen, Yi-Jie Kuo, Wei-Lung Tseng, Yuan-Shen Chen, Chin-Jung Lin, Chun-Jen Liao, Feng-Huei Lin, and Chang-Jung Chiang.
• Institute of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan No. 1, Sec. 1, Jen-Ai Road, Taipei City, 100, Taiwan; Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan No. 7, Chung-Shan South Road, Taipei City 100, Taiwan; Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan No. 579, Yun-Lin Road, Diou-Liu City, Yun-Lin County, 640, Taiwan; Kinmen Hospital, Ministry of Health and Welfare, Kinmen County, Taiwan No. 2, Fu-Xing Road, Kin-Hu Township, Kin-Men County, 891, Taiwan.
• Spine J. 2017 Sep 1; 17 (9): 1373-1380.

Background ContextMinimally invasive spine surgery has become increasingly popular in clinical practice, and it offers patients the potential benefits of reduced blood loss, wound pain, and infection risk, and it also diminishes the loss of working time and length of hospital stay. However, surgeons require more intraoperative fluoroscopy and ionizing radiation exposure during minimally invasive spine surgery for localization, especially for guidance in instrumentation placement. In addition, computer navigation is not accessible in some facility-limited institutions.PurposeThis study aimed to demonstrate a method for percutaneous screws placement using only the anterior-posterior (AP) trajectory of intraoperative fluoroscopy.Study DesignA technical report (a retrospective and prospective case series) was carried out.Patient SamplePatients who received posterior fixation with percutaneous pedicle screws for thoracolumbar degenerative disease or trauma comprised the patient sample.MethodWe retrospectively reviewed the charts of consecutive 670 patients who received 4,072 pedicle screws between December 2010 and August 2015. Another case series study was conducted prospectively in three additional hospitals, and 88 consecutive patients with 413 pedicle screws were enrolled from February 2014 to July 2016. The fluoroscopy shot number and radiation dose were recorded. In the prospective study, 78 patients with 371 screws received computed tomography at 3 months postoperatively to evaluate the fusion condition and screw positions.ResultsIn the retrospective series, the placement of a percutaneous screw required 5.1 shots (2-14, standard deviation [SD]=2.366) of AP fluoroscopy. One screw was revised because of a medialwall breach of the pedicle. In the prospective series, 5.8 shots (2-16, SD=2.669) were required forone percutaneous pedicle screw placement. There were two screws with a Grade 1 breach (8.6%), both at the lateral wall of the pedicle, out of 23 screws placed at the thoracic spine at T9-T12. Forthe lumbar and sacral areas, there were 15 Grade 1 breaches (4.3%), 1 Grade 2 breach (0.3%), and 1 Grade 3 breach (0.3%). No revision surgery was necessary.ConclusionThis method avoids lateral shots of fluoroscopy during screw placement and thus decreases the operation time and exposes surgeons to less radiation. At the same time, compared with the computer-navigated procedure, it is less facility-demanding, and provides satisfactory reliability and accuracy.Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

31 keywords...

hide…