Percutaneous instrumentation of the cervical and cervico-thoracic spine using pedicle screws: preliminary clinical results and analysis of accuracy.
Standard
Percutaneous instrumentation of the cervical and cervico-thoracic spine using pedicle screws: preliminary clinical results and analysis of accuracy. / Schäfer, Christian; Begemann, Philipp; Fuhrhop, Ina; Schröder, Malte; Viezens, Lennart; Wiesner, Lothar; Hansen-Algenstaedt, Nils.
In: EUR SPINE J, Vol. 20, No. 6, 6, 2011, p. 977-985.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Percutaneous instrumentation of the cervical and cervico-thoracic spine using pedicle screws: preliminary clinical results and analysis of accuracy.
AU - Schäfer, Christian
AU - Begemann, Philipp
AU - Fuhrhop, Ina
AU - Schröder, Malte
AU - Viezens, Lennart
AU - Wiesner, Lothar
AU - Hansen-Algenstaedt, Nils
PY - 2011
Y1 - 2011
N2 - 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.
AB - 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.
KW - Adult
KW - Humans
KW - Male
KW - Aged
KW - Female
KW - Middle Aged
KW - Treatment Outcome
KW - Bone Screws
KW - Cervical Vertebrae/radiography/surgery
KW - Fluoroscopy/instrumentation
KW - Spinal Diseases/radiography/surgery
KW - Spinal Fusion/instrumentation
KW - Surgery, Computer-Assisted/instrumentation
KW - Thoracic Vertebrae/surgery
KW - Adult
KW - Humans
KW - Male
KW - Aged
KW - Female
KW - Middle Aged
KW - Treatment Outcome
KW - Bone Screws
KW - Cervical Vertebrae/radiography/surgery
KW - Fluoroscopy/instrumentation
KW - Spinal Diseases/radiography/surgery
KW - Spinal Fusion/instrumentation
KW - Surgery, Computer-Assisted/instrumentation
KW - Thoracic Vertebrae/surgery
M3 - SCORING: Journal article
VL - 20
SP - 977
EP - 985
JO - EUR SPINE J
JF - EUR SPINE J
SN - 0940-6719
IS - 6
M1 - 6
ER -