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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. Insert a Jamshidi Needle through the mid-line incision and dock the tip on the inferior articular surface of the superior facet. Confirm position by using lateral fluoroscopy. Gently tap the Jamshidi Needle until the distal tip has reached the inferior facet
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Figure 3: Artist's drawing. Insert a Jamshidi Needle through the mid-line incision and dock the tip on the inferior articular surface of the superior facet. Confirm position by using lateral fluoroscopy. Gently tap the Jamshidi Needle until the distal tip has reached the inferior facet

Mentions: The morbidity added to the procedure by the facet screws, is easily understood by the graphic demonstration of the facet screw trajectory provided by the authors in their illustrations. The angle of incidence of the facet screw is too acute [Figure 2b], since it does not follow the direction of the pedicle, and instead traverses from the superior to the inferior margin of the pedicle. The acuteness of the angle of incidence is clearly demonstrated by the CT scan image, which shows the tip of the facet screw at the level of the cortex of the pedicle [Figure 4a]. Using fluoroscopic imaging, the probability of penetration of the cortex of the pedicle is greater, since it is hard to know exactly where the tip of the screw lies. It must be remembered that the exiting nerve root hugs the inferior surface of the pedicle above, and can be easily injured by any transgression of the pedicle cortex.


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. Insert a Jamshidi Needle through the mid-line incision and dock the tip on the inferior articular surface of the superior facet. Confirm position by using lateral fluoroscopy. Gently tap the Jamshidi Needle until the distal tip has reached the inferior facet
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Artist's drawing. Insert a Jamshidi Needle through the mid-line incision and dock the tip on the inferior articular surface of the superior facet. Confirm position by using lateral fluoroscopy. Gently tap the Jamshidi Needle until the distal tip has reached the inferior facet
Mentions: The morbidity added to the procedure by the facet screws, is easily understood by the graphic demonstration of the facet screw trajectory provided by the authors in their illustrations. The angle of incidence of the facet screw is too acute [Figure 2b], since it does not follow the direction of the pedicle, and instead traverses from the superior to the inferior margin of the pedicle. The acuteness of the angle of incidence is clearly demonstrated by the CT scan image, which shows the tip of the facet screw at the level of the cortex of the pedicle [Figure 4a]. Using fluoroscopic imaging, the probability of penetration of the cortex of the pedicle is greater, since it is hard to know exactly where the tip of the screw lies. It must be remembered that the exiting nerve root hugs the inferior surface of the pedicle above, and can be easily injured by any transgression of the pedicle cortex.

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