A novel retractor for reducing operation time and radiation exposure in percutaneous pedicle screw placement

Abstract

Background : Percutaneous pedicle screw fixation is less damage to the surrounding musculature and can decrease both blood loss and recovery time, but depends heavily on fluoroscopic guidance. An efficient instrument or system that allows for accurate pedicle screw placement and reduction in the fluoroscopy shot time would therefore be of value. Methods: 126 patients with single segment thoracolumbar vertebral fracture were surgically treated with percutaneous pedicle screws through our novel retractor technique group A or traditional fluoroscopic method(group B), the operation time and fluoroscopy shot times were compared, and the accuracy of screw placement were assessed. Results : There was no serious complications occurring during our study, such as infection, blood vessel injury, spinal cord or nerve root injury. We did not find any statistically difference between the two groups in corrected rate of regional Cobb's angle or vertebral body height percentage(P>0.05); however, the mean operation time was found to be 75.9±2.37min in the novel retractor method group and 94.2±2.19min in the traditional method group. The difference was statistically significant (p 0.001). Fluoroscopy shot times averaged 9.01±0.41 in the novel retractor group versus 16.8±0.56 in the traditional group (P < 0.001), the novel retractor group had apparent advantages over the traditional method in postoperative improvement on visual analog scale (VAS) scores and Oswestry Disability Index (ODI) at 2days, 3month after operation and last follow-up (P<0.05). There was no statistical difference between the novel retractor group and traditional method group in the radiographic results and screw position violation grade. Conclusion: The novel retractor method had several advantages, including shorter operation time, less fluoroscopy shot times, and better postoperative improvement on visual analog scale(VAS) score and Oswestry Disability Index (ODI). It provides a new alternative method for effective management of thoracolumbar fractures. Background: Percutaneous pedicle screw fixation offer a less traumatic approach resulting in less damage to the surrounding musculature and a decrease in both blood loss and recovery time[1-5]. These