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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

(a) Sagittal CT image to show the transpedicular facet screw into the vertebral body. (b) Sagittal CT image to show bony interbody fusion
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Figure 6: (a) Sagittal CT image to show the transpedicular facet screw into the vertebral body. (b) Sagittal CT image to show bony interbody fusion

Mentions: During the study period from January 2010 to December 2011, a total of 40 patients received a one-level decompression and TLIF with pedicle screws insertion through a unilateral Wiltse approach and then a contralateral percutaneous transpedicular facet screw insertion [Figures 3 and 4]. There were 20 men and 20 women with an average age of 57.5 (range, 27-82) years. Twenty-three patients had surgery at the L4-L5 level, 14 at the L5-S1 level, and 3 at the L3-L4 level. The average surgical time was 124 (range, 97-167) minutes. The surgery documented at 167 minutes was a trial of computer-assisted navigation system and was the only case where the navigation was used. The EBL of the surgery was 140 cc. No blood transfusion was necessary in any of these patients. The average LOS in the hospital after the surgery was 3 (range, 1-6) days.


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)

(a) Sagittal CT image to show the transpedicular facet screw into the vertebral body. (b) Sagittal CT image to show bony interbody fusion
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: (a) Sagittal CT image to show the transpedicular facet screw into the vertebral body. (b) Sagittal CT image to show bony interbody fusion
Mentions: During the study period from January 2010 to December 2011, a total of 40 patients received a one-level decompression and TLIF with pedicle screws insertion through a unilateral Wiltse approach and then a contralateral percutaneous transpedicular facet screw insertion [Figures 3 and 4]. There were 20 men and 20 women with an average age of 57.5 (range, 27-82) years. Twenty-three patients had surgery at the L4-L5 level, 14 at the L5-S1 level, and 3 at the L3-L4 level. The average surgical time was 124 (range, 97-167) minutes. The surgery documented at 167 minutes was a trial of computer-assisted navigation system and was the only case where the navigation was used. The EBL of the surgery was 140 cc. No blood transfusion was necessary in any of these patients. The average LOS in the hospital after the surgery was 3 (range, 1-6) days.

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