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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

Artist's drawing. 1 cm mid-line skin incision is made at least one level above the desired surgical level. The planned trajectory should begin at mid-line and proceeds medial to lateral. Aim for the center of the inferior articular process of the superior facet in order to cross the facet joint into the pedicle
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Figure 2: Artist's drawing. 1 cm mid-line skin incision is made at least one level above the desired surgical level. The planned trajectory should begin at mid-line and proceeds medial to lateral. Aim for the center of the inferior articular process of the superior facet in order to cross the facet joint into the pedicle

Mentions: A separate 1 cm mid-line incision was made at about one to two levels cephalad to the fusion level. The distance was adjusted according to the lordotic curvature and the body mass index of the patient. The planned trajectory aimed for the center of the contralateral inferior articular process of the superior facet in order to cross the facet joint into the pedicle [Figure 2]. A Jamshidi Needle was inserted through the mid-line incision and the tip was docked on the inferior articular surface of the superior facet. Trajectory was confirmed by using A/P and lateral fluoroscopy. In the A/P view, the tip of the needle was aimed toward the 5 or 7 O’clock position of the pedicle of the lower vertebra. In the lateral view, the trajectory was passing through the facet joint into the pedicle of the lower vertebra body. The Jamshidi Needle was gently tapped until the distal tip reached the inferior facet. The inner stylet of the Jamshidi Needle was removed, and a sharp tip guidewire was inserted into the Jamshidi Needle. Using a high-speed cannulated power drill, the guidewire was advanced across the superior and inferior facets and into the pedicle. The wire depth was confirmed with lateral fluoroscopy to ensure that the guidewire had reached beyond the pedicle into the body. The appropriate length of the facet screw was measured through the markings on the guidewire. The cannulated high-speed drill assembly was placed across the wire and the drill bit was advanced through the superior and inferior facets and into the pedicle. Using the cannulated self-retaining screwdriver, the lagged facet screw was guided through the guidewire, down to the inferior articular surface of the superior facet, and into the pedicle. The appropriate implant positioning with fluoroscopy to make sure that the facet joint is fully lagged and that the screw has been sufficiently tightened into position is then confirmed.


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)

Artist's drawing. 1 cm mid-line skin incision is made at least one level above the desired surgical level. The planned trajectory should begin at mid-line and proceeds medial to lateral. Aim for the center of the inferior articular process of the superior facet in order to cross the facet joint into the pedicle
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Artist's drawing. 1 cm mid-line skin incision is made at least one level above the desired surgical level. The planned trajectory should begin at mid-line and proceeds medial to lateral. Aim for the center of the inferior articular process of the superior facet in order to cross the facet joint into the pedicle
Mentions: A separate 1 cm mid-line incision was made at about one to two levels cephalad to the fusion level. The distance was adjusted according to the lordotic curvature and the body mass index of the patient. The planned trajectory aimed for the center of the contralateral inferior articular process of the superior facet in order to cross the facet joint into the pedicle [Figure 2]. A Jamshidi Needle was inserted through the mid-line incision and the tip was docked on the inferior articular surface of the superior facet. Trajectory was confirmed by using A/P and lateral fluoroscopy. In the A/P view, the tip of the needle was aimed toward the 5 or 7 O’clock position of the pedicle of the lower vertebra. In the lateral view, the trajectory was passing through the facet joint into the pedicle of the lower vertebra body. The Jamshidi Needle was gently tapped until the distal tip reached the inferior facet. The inner stylet of the Jamshidi Needle was removed, and a sharp tip guidewire was inserted into the Jamshidi Needle. Using a high-speed cannulated power drill, the guidewire was advanced across the superior and inferior facets and into the pedicle. The wire depth was confirmed with lateral fluoroscopy to ensure that the guidewire had reached beyond the pedicle into the body. The appropriate length of the facet screw was measured through the markings on the guidewire. The cannulated high-speed drill assembly was placed across the wire and the drill bit was advanced through the superior and inferior facets and into the pedicle. Using the cannulated self-retaining screwdriver, the lagged facet screw was guided through the guidewire, down to the inferior articular surface of the superior facet, and into the pedicle. The appropriate implant positioning with fluoroscopy to make sure that the facet joint is fully lagged and that the screw has been sufficiently tightened into position is then confirmed.

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