Percutaneous placement of pedicle screws in overweight and obese patients

Park, Yung; Ha, Joong Won; Lee, Yun Tae; Sung, Na Young

doi:10.1016/j.spinee.2011.07.029

Cited by 29 publications

(20 citation statements)

References 16 publications

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“…This is consistent with the experience of other authors 2,8,15 and was probably related to the higher prevalence of hypertrophic facet joints in the lower lumbar spine, as it is sometimes difficult to go lateral enough to avoid the joint. Babu et al…”

Section: 6supporting

confidence: 92%

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Use of anteroposterior view fluoroscopy for targeting percutaneous pedicle screws in cases of spinal deformity with axial rotation

Ahmad¹,

Wang²

2014

SPI

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Object Over the past decade percutaneous pedicle screws have become popular for the minimally invasive treatment of spinal disorders. However, until the last 5 years the presence of a significant spinal deformity was regarded as a relative contraindication for percutaneous instrumentation. Recent advances in surgical technique and intraoperative technology have made percutaneous fixation in complex spinal pathologies more commonplace. The authors report their experience using a parsimonious method for uniplanar fluoroscopic targeting of pedicles in challenging cases. Methods The authors performed a retrospective analysis of patients with adult spinal deformity who underwent percutaneous pedicle screw instrumentation from 2008 to 2013. Cases were included if a spiral slice postoperative CT scan was obtained. All cases had a minimum of 10° of axial rotation and typically had additional accompanying anatomical abnormalities. Screws were assessed for any pedicle violations as well as any impingement of the surrounding facet joints. Results A total of 410 pedicle screws were placed in 36 patients with an average 6.4 levels of instrumentation per patient. The mean age was 67 years (range 44–86 years) and there were 25 females. Of the 410 screws, 29 (7.1%) had some medial or lateral pedicle violation. Of these, 15 (3.7%) were Grade 1, 6 (1.4%) were Grade 2, and 8 (2.0%) were Grade 3 violations. Of the Grade 3 violations, 2 each were at the L-4, L-5, and S-1 levels, and 1 each was at the T-10 and L-1 levels. Two of the patients had symptoms and both underwent screw repositioning, one during the same admission and the other in a delayed fashion. Both were at the L-5 and S-1 levels with anatomically highly medialized pedicles. There were no motor deficits, and both removals were for numbness. Of the 72 screws at the proximal end of the construct, there were 6 facet violations (8.3%). Four (5.6%) of these were Grade 1, 1 (1.4%) was Grade 2, and 1 (1.4%) was Grade 3. Conclusions The anteroposterior fluoroscopic technique can be effectively used by spinal surgeons to cannulate the pedicles in patients with rotational deformities. The complication rate in this challenging population is acceptable and is in accordance with the existing literature. However, caution should be used at L-5 and S-1 when the pedicle is narrow and highly medialized, rendering an indistinct medial wall on anteroposterior imaging.

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Section: 6supporting

confidence: 92%

“…Most of these were at the lower lumbar levels (Table 1), which is consistent with the reports in literature. 15 Two patients in this series underwent hardware repositioning. The L-5 and S-1 pedicles are typically the largest in size in the lumbar spine.…”

mentioning

confidence: 97%

Use of anteroposterior view fluoroscopy for targeting percutaneous pedicle screws in cases of spinal deformity with axial rotation

Ahmad¹,

Wang²

2014

SPI

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“…The decreased paraspinal muscle trauma and shorter surgical incision are advantageous in percutaneous pedicle screw placement. A lower infection rate was also encountered, particularly in obese patients with associated diabetes [14].…”

Section: Discussionmentioning

confidence: 85%

Minimally Invasive Stabilization for Thoracolumbar Fractures

SarÄ±kafa¹,

Demirkol²,

Peker³

et al. 2013

J Spine

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Minimally invasive approaches are becoming increasingly widespread due to numerous potential advantages (smaller scars, diminished local pain, reduced blood loss, reduced postoperative wound pain, shorter hospital stays) in spinal surgery. Nowadays, minimally invasive stabilization is more frequently used to treat some thoracolumbar fractures. The aim of this study is to explore the feasibility and effect of minimally invasive stabilization for the treatment of unstable thoracolumbar fractures without neurological impairment. From October 2011 to February 2012, 20 patients with thoracolumbar fracture who were treated with minimally invasive stabilization were included in this study. Charts and operative notes were analyzed for epidemiological data, injured segments, operative time, bleeding volume, mobilization interval, complications and lengths of stay. All patients were successfully managed with minimally invasive stabilization. There were 14 males and 6 females with a mean age of 33.75 years ranging from 18 to 59 years. The L1 vertebra was the most injured vertebral level (35%), followed by T12 and L2. Mechanisms of injury included falling from a height (12 patients) and traffic accidents (8 patients). The average operative time was 72 minutes (range 60 to 122 min). The average intraoperative blood loss was 80 ml (range 50 to 270 ml). Minimally invasive instrumentation of the spine reduces intraoperative blood loss, soft tissue trauma, operative time, infection rates and hospital stay. Future developments in minimally invasive technology will lead to improved results with increased indications and applications.

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“…The authors found a higher rate of misplaced screws in the overweight group compared to the obese and normal weight groups. However, this difference was not significant, possibly due to the small size of patients (23). The screws which were misplaced and symptomatic were observed in the overweight and obese groups of patients.…”

Section: Operative Variablesmentioning

confidence: 80%

“…Obesity affects image quality; the density of the patient's fat and BMI will degrade the image quality of image intensifier used intraoperatively to confirm screw placement. Park et al (23) assessed body habitus as factors for the misplacement of percutaneous lumbar pedicle screws. The authors found a higher rate of misplaced screws in the overweight group compared to the obese and normal weight groups.…”

Section: Operative Variablesmentioning

confidence: 99%

Accuracy of minimally invasive percutaneous thoracolumbar pedicle screws using 2D fluoroscopy: a retrospective review through 3D CT analysis

Winder

Gilhooly

2017

J. Spine Surg.

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Background: In the literature, there is a large variation in the reported misplacement rates of pedicle screws.The use of minimally invasive surgical techniques is increasing and as such there has only been a small amount of data to look at the misplacement rate of percutaneously inserted thoracic and lumbar pedicle screws.Methods: A retrospective analysis of post-operative computed tomography (CT) scans were performed on 108 patients who underwent minimally invasive percutaneously inserted thoracic and lumbar pedicle screws by a single surgeon. Analysis of the screw trajectory using strict guidelines was performed using multiplanar reconstruction CT scan data to determine the accuracy of the pedicle screws.Results: A total of 614 screws were inserted in vertebral levels T2 to S1. Twenty-five (4.07%) screws were considered misplaced having breached the pedicular cortex. Thoracic pedicle screws had a statistically higher misplacement rate than lumbar pedicle screws (14.67% vs. 2.60% respectively, P<0.001). A single screw required replacement (0.16%) and there were no permanent neurological deficits. The misplacement rates were lower than those reported for open screw placement and equivalent to 3D CT navigated misplacement rates.Conclusions: Percutaneously inserted pedicle screws using 2D fluoroscopy offers a safe and accurate option for spinal stabilisation with an extremely low misplacement rate and morbidity. Overall, the low misplacement rates were equivalent and in most cases lower compared to open and computer assisted navigation techniques.However, we would recommend that given a misplacement rate of 14.67% for thoracic pedicle screws that computer assisted navigation may be able to offer further improvements in accuracy.

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Percutaneous placement of pedicle screws in overweight and obese patients

Cited by 29 publications

References 16 publications

Use of anteroposterior view fluoroscopy for targeting percutaneous pedicle screws in cases of spinal deformity with axial rotation

Use of anteroposterior view fluoroscopy for targeting percutaneous pedicle screws in cases of spinal deformity with axial rotation

Minimally Invasive Stabilization for Thoracolumbar Fractures

Accuracy of minimally invasive percutaneous thoracolumbar pedicle screws using 2D fluoroscopy: a retrospective review through 3D CT analysis

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