Direct pedicle visualization and disc space orientation as the only guide for lumbar pedicular screw insertion

Abstract

Background: Different methods for lumbar pedicular screw insertion have been advocated; however, each technique has its cons and pros. Limited resources for O-arm and navigation in our locality enforced us to use our surgical skills to minimize the need for such advanced modalities. The aim of the study is to clarify the benefits of the use of free-hand technique using direct visualization of the pedicles and disc space as the only guide for pedicular screw insertion using postoperative CT for evaluation of the accuracy of pedicle screw insertion. Patients and methods: One hundred forty-four screws were inserted in 32 patients using direct pedicle visualization and disc space orientation as a single intraoperative reference guide. The study was conducted in Zagazig University Hospitals from May, 2014, to June, 2015. CT was done for all patients as a direct postoperative evaluation tool. Results: There were 24 cases of single-level lumbar degenerative spondylolisthesis (96 screws) and eight with double-level degenerative spondylolisthesis DSL (48 screws). One hundred forty-four screws were inserted. Only three out of 144 screws were not purely intrapedicular; superior and lateral violations were not clinically significant. Conclusions: Direct pedicle visualization with the use of disc space orientation as a reference guide is a good alternative to the most advanced intraoperative monitoring techniques that are more readily available in developed countries.