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Neurosurg Focus. 2017 Aug;43(2):E9. doi: 10.3171/2017.5.FOCUS17200.

Minimally invasive guidewireless, navigated pedicle screw placement: a technical report and case series.

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Department of Neurosurgery, Michigan Medicine, Ann Arbor, Michigan.


OBJECTIVE Percutaneous pedicle screw insertion (PPSI) is a mainstay of minimally invasive spinal surgery. Traditionally, PPSI is a fluoroscopy-guided, multistep process involving traversing the pedicle with a Jamshidi needle, placement of a Kirschner wire (K-wire), placement of a soft-tissue dilator, pedicle tract tapping, and screw insertion over the K-wire. This study evaluates the accuracy and safety of PPSI with a simplified 2-step process using a navigated awl-tap followed by navigated screw insertion without use of a K-wire or fluoroscopy. METHODS Patients undergoing PPSI utilizing the K-wire-less technique were identified. Data were extracted from the electronic medical record. Complications associated with screw placement were recorded. Postoperative radiographs as well as CT were evaluated for accuracy of pedicle screw placement. RESULTS Thirty-six patients (18 male and 18 female) were included. The patients' mean age was 60.4 years (range 23.8-78.4 years), and their mean body mass index was 28.5 kg/m2 (range 20.8-40.1 kg/m2). A total of 238 pedicle screws were placed. A mean of 6.6 pedicle screws (range 4-14) were placed over a mean of 2.61 levels (range 1-7). No pedicle breaches were identified on review of postoperative radiographs. In a subgroup analysis of the 25 cases (69%) in which CT scans were performed, 173 screws were assessed; 170 (98.3%) were found to be completely within the pedicle, and 3 (1.7%) demonstrated medial breaches of less than 2 mm (Grade B). There were no complications related to PPSI in this cohort. CONCLUSIONS This streamlined 2-step K-wire-less, navigated PPSI appears safe and accurate and avoids the need for radiation exposure to surgeon and staff.


AP = anteroposterior; ASA = American Society of Anesthesiologists; BMI = body mass index; GRS = Gertzbein and Robbins system; K-wire; K-wire = Kirschner wire; LLIF = lateral lumbar interbody fusion; PPSI = percutaneous pedicle screw insertion; TLIF = transforaminal lumbar interbody fusion; fusion; iCBCT = intraoperative cone-beam CT; image guided; minimally invasive; navigation; pedicle screw; spine

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