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Minimally invasive one-level lumbar decompression and fusion surgery with posterior instrumentation using a combination of pedicle screw fixation and transpedicular facet screw construct.

Hsiang J, Yu K, He Y - Surg Neurol Int (2013)

Bottom Line: Two patients developed new leg pain on the side where the facet screw had been placed.Both patients had the facet screw removed.However, caution is needed during the placement of the percutaneous facet screw in order to avoid nerve root injury.

View Article: PubMed Central - PubMed

Affiliation: Swedish Neuroscience Institute, 550 17 Avenue, Suite 500, Seattle, WA 98122, USA.

ABSTRACT

Background: Minimally invasive lumbar spine fusion surgery has gained popularity in recent years. Routinely, this technique requires bilateral parasagittal incisions for decompression, interbody fusion, and posterior instrumentation. The following study is a description of a new minimally invasive technique for one-level transforaminal lumbar interbody fusion (TLIF) using a unilateral parasagittal incision (Wiltse approach), with placement of pedicle screws and then a percutaneous transpedicular facet screw insertion on the contralateral side. The biomechanical stability of this posterior construct will be discussed while the efficacy and complications of this technique have been examined.

Methods: Forty patients underwent this new technique of one-level TLIF with posterior instrumentation using unilateral pedicle screw fixation supplemented with contralateral percutaneous transpedicular facet screw construct. Data regarding surgical time, estimated blood loss (EBL), hospital length of stay (LOS), and complications related to the posterior instrumentation are recorded.

Results: The average surgical time of this new procedure was 124 minutes; average EBL was 140 cc; average hospital LOS was 3 days. Two patients developed new leg pain on the side where the facet screw had been placed. Both patients had the facet screw removed.

Conclusion: This novel technique of unilateral pedicle screw fixation combined with contralateral percutaneous transpedicular facet screw construct has further reduced the amount of normal tissue injury while maintaining the same biomechanical advantages of bilateral pedicle screw fixation. However, caution is needed during the placement of the percutaneous facet screw in order to avoid nerve root injury.

No MeSH data available.


Related in: MedlinePlus

MRI of the axial view of lumbar spine and muscles. Arrow points to the path of Wiltse Approach, the muscle plane between the longissimus muscle (LS) and the multifidus muscle (MF)
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Figure 1: MRI of the axial view of lumbar spine and muscles. Arrow points to the path of Wiltse Approach, the muscle plane between the longissimus muscle (LS) and the multifidus muscle (MF)

Mentions: The patient was put in prone position on a Jackson table. O-arm fluoroscopy was used for A/P and lateral imaging during the surgery. A 4 cm parasagittal incision was made at the level of interest. The incision is about 3 cm from the mid-line, or along the line of the pedicles. The incision was made on the right side or left side depending on which side of the leg the patient felt more radicular pain. After the incision was made and the lumbar fascia opened, the natural muscle plane between the multifidus and longissimus muscle groups were identified [Figure 1]. Blunt dissection was made through this muscle plane using the surgeon's index finger. The facet joint could be felt. Retractor was applied, and the facet joint exposed. The facet joint was removed by a combination of osteotome and power drill. The bony fragments were collected for later fusion use. Kerrison rongeur was used to complete the decompression and the nerve in the foramen was exposed and decompressed. If indicated, the central canal and even contralateral lateral recess could be decompressed using the Kerrison rongeur while compressing on the thecal sac. After satisfactory decompression of the neural structures, diskectomy was then performed through the Kambie's triangle.[8] Extra effort was made for a thorough diskectomy and preparation of the end plates to facilitate the interbody fusion. The interbody space was then packed with the graft materials. The graft materials were made up of the patient's autologous bone fragments from the removed facet joint and synthetic bone graft mixed with the patient's bone marrow aspirate from the vertebral body. A peek cage packed with the graft materials was then inserted obliquely from the Kambin's triangle into the disc space. Pedicle screws were then inserted through the same incision under direct visualization and with the help of lateral imaging. The pedicle screws were connected using a lordortic rod. The fascia and the skin were then closed with absorbable suture.


Minimally invasive one-level lumbar decompression and fusion surgery with posterior instrumentation using a combination of pedicle screw fixation and transpedicular facet screw construct.

Hsiang J, Yu K, He Y - Surg Neurol Int (2013)

MRI of the axial view of lumbar spine and muscles. Arrow points to the path of Wiltse Approach, the muscle plane between the longissimus muscle (LS) and the multifidus muscle (MF)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3814991&req=5

Figure 1: MRI of the axial view of lumbar spine and muscles. Arrow points to the path of Wiltse Approach, the muscle plane between the longissimus muscle (LS) and the multifidus muscle (MF)
Mentions: The patient was put in prone position on a Jackson table. O-arm fluoroscopy was used for A/P and lateral imaging during the surgery. A 4 cm parasagittal incision was made at the level of interest. The incision is about 3 cm from the mid-line, or along the line of the pedicles. The incision was made on the right side or left side depending on which side of the leg the patient felt more radicular pain. After the incision was made and the lumbar fascia opened, the natural muscle plane between the multifidus and longissimus muscle groups were identified [Figure 1]. Blunt dissection was made through this muscle plane using the surgeon's index finger. The facet joint could be felt. Retractor was applied, and the facet joint exposed. The facet joint was removed by a combination of osteotome and power drill. The bony fragments were collected for later fusion use. Kerrison rongeur was used to complete the decompression and the nerve in the foramen was exposed and decompressed. If indicated, the central canal and even contralateral lateral recess could be decompressed using the Kerrison rongeur while compressing on the thecal sac. After satisfactory decompression of the neural structures, diskectomy was then performed through the Kambie's triangle.[8] Extra effort was made for a thorough diskectomy and preparation of the end plates to facilitate the interbody fusion. The interbody space was then packed with the graft materials. The graft materials were made up of the patient's autologous bone fragments from the removed facet joint and synthetic bone graft mixed with the patient's bone marrow aspirate from the vertebral body. A peek cage packed with the graft materials was then inserted obliquely from the Kambin's triangle into the disc space. Pedicle screws were then inserted through the same incision under direct visualization and with the help of lateral imaging. The pedicle screws were connected using a lordortic rod. The fascia and the skin were then closed with absorbable suture.

Bottom Line: Two patients developed new leg pain on the side where the facet screw had been placed.Both patients had the facet screw removed.However, caution is needed during the placement of the percutaneous facet screw in order to avoid nerve root injury.

View Article: PubMed Central - PubMed

Affiliation: Swedish Neuroscience Institute, 550 17 Avenue, Suite 500, Seattle, WA 98122, USA.

ABSTRACT

Background: Minimally invasive lumbar spine fusion surgery has gained popularity in recent years. Routinely, this technique requires bilateral parasagittal incisions for decompression, interbody fusion, and posterior instrumentation. The following study is a description of a new minimally invasive technique for one-level transforaminal lumbar interbody fusion (TLIF) using a unilateral parasagittal incision (Wiltse approach), with placement of pedicle screws and then a percutaneous transpedicular facet screw insertion on the contralateral side. The biomechanical stability of this posterior construct will be discussed while the efficacy and complications of this technique have been examined.

Methods: Forty patients underwent this new technique of one-level TLIF with posterior instrumentation using unilateral pedicle screw fixation supplemented with contralateral percutaneous transpedicular facet screw construct. Data regarding surgical time, estimated blood loss (EBL), hospital length of stay (LOS), and complications related to the posterior instrumentation are recorded.

Results: The average surgical time of this new procedure was 124 minutes; average EBL was 140 cc; average hospital LOS was 3 days. Two patients developed new leg pain on the side where the facet screw had been placed. Both patients had the facet screw removed.

Conclusion: This novel technique of unilateral pedicle screw fixation combined with contralateral percutaneous transpedicular facet screw construct has further reduced the amount of normal tissue injury while maintaining the same biomechanical advantages of bilateral pedicle screw fixation. However, caution is needed during the placement of the percutaneous facet screw in order to avoid nerve root injury.

No MeSH data available.


Related in: MedlinePlus