Introduction: Several guidance techniques have been employed in the effort to increase the accuracy and reduce surgical time during percutaneous pedicle screws placement. Aim of this study is to present a novel technique for percutaneous lumbar pedicle screws placement that reduce surgical time and radiation exposure for the Operative Room (OR) personnel.
Methods: We reviewed 11 cases with percutaneous pedicle screws placement in lumbar Minimal Invasive Surgical (MIS) techniques (6 XLIFs-3 ALIFs-2 TLIFs). The patients were 7 males and 4 women with a median age of 58.78 years old and a median BMI of 35.25 kgr/m2. Integrated computer guided navigation system was used in all cases. A hand held drill with a navigated drill guide was used in order to create the path for the guidewires insertion through the pedicles to the vertebral bodies. The length of the inserted drill could be adjusted and controlled from the surgeon through specific markers on the hand drill. Intraoperative confirmation with anterior-posterior (AP) fluoroscopy was obtained through out the procedure. After the removal of the hand held drill, the placement of the screws took place through the guidewires to the pedicles. A final intraoperative CT was performed after the screw placement in order to ensure their optimal position.
Results: There were no intra-operative complications through this technique. Pedicle screws placement was correct in all the performed cases. The average time for every pedicle screw placement was 7.5 minutes. The radiation exposure through intra-operative fluoroscopy reduced 18.14 mGy from the total received dose without navigational placement of the guidewires. There were no significant differences in blood loss.
Conclusions: This described technique is timely efficient and contributes to reduced radiation exposure for the OR personnel
Patient Care: By introducing a percutaneous pedicle screw insertion technique that reduces the exposure to radiation as well as the surgical time.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) understand the usefulness of the described pedicle screw insertion technique in the avoidance of intra-operative complications, 2) understand the validity of the described technique in reducing the exposure to radiation