Percutaneous instrumentation of the cervical and cervico-thoracic spine using pedicle screws: preliminary clinical results and analysis of accuracy
| Autor: | Nils Hansen-Algenstaedt, Lennart Viezens, Lothar Wiesner, Malte Schroeder, Christian Schaefer, Phillip Begemann, Ina Fuhrhop |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2011 |
| Předmět: |
musculoskeletal diseases
Adult Male medicine.medical_specialty Percutaneous Vertebral artery medicine.medical_treatment Bone Screws Thoracic Vertebrae medicine.artery medicine Foramen Humans Orthopedics and Sports Medicine Ideas and Technical Innovations Aged business.industry Fascia Middle Aged Neurovascular bundle musculoskeletal system Surgery medicine.anatomical_structure Spinal Fusion Treatment Outcome Surgery Computer-Assisted Spinal fusion Fluoroscopy Thoracic vertebrae Cervical Vertebrae Female Spinal Diseases Radiology business Cervical vertebrae |
| Popis: | The pedicle screw instrumentation represents the most rigid construct of the cervical and cervicothoracic spine and in spite of the risks to neurovascular structures clinical relevant complications do not occur frequently. The steep angles of the cervical pedicles result in a wide surgical exposure with extensive muscular trauma. The objective of this study was the evaluation of the accuracy of cervical pedicle screw insertion through a minimally invasive technique to reduce access-related muscular trauma. Therefore, percutaneous transpedicular instrumentation of the cervical and cervicothoracic spine was performed in 15 patients using fluoroscopy. All instrumentations from C2 to Th4 were inserted bilaterally through 2 to 3-cm skin and fascia incisions even in multilevel procedures and the rods were placed by blunt insertion through the incision. Thin-cut CT scan was used postoperatively to analyze pedicle violations. 76.4% of 72 screws were placed accurately. Most pedicle perforations were seen laterally towards the vertebral artery. Critical breaches >2 mm or narrowing of the transversal foramen occurred in 12.5% of screws; however, no revision surgery for screw displacement was needed in the absence of clinical symptoms. No conversion from percutaneous to open surgery was necessary. It was concluded that percutaneous transpedicular instrumentation of the cervical spine is a surgically demanding technique and should be reserved for experienced spine surgeons. The indications are limited to instrumentation-only procedures or in combination with anterior treatment, but with the potential to minimize access-related morbidity. |
| Databáze: | OpenAIRE |
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