Percutaneous techniques for minimally invasive posterior lumbar fusion

Abstract

<jats:p>Percutaneous pedicle screw fixation for lumbar posterolateral instrumented fusion is an attractive alternative to standard open techniques. The technical aspects of this procedure can be challenging and even frustrating when first learning the technique. However, once these techniques have been mastered, they offer a safe, less invasive, less traumatic, more aesthetic method for performing fusion. The authors have outlined a step-by-step method for performing this surgery, and include a case series that demonstrates excellent results in patients treated with this procedure.</jats:p>

Factors affecting the accurate placement of percutaneous pedicle screws during minimally invasive transforaminal lumbar interbody fusion

“…Facet osteoarthritis may distort the contour of the superior articular process, making this structure difficult to use as an anatomical landmark [3]. The insertion of S1 screws is frequently interrupted by the iliac crest [4,12].…”

“…It was also applied to test the immobilization effect for lower back pain [9,10]. As tissue damage during spinal instrumentation and postoperative morbidity can be minimized using this technique, it became popularized as a minimally invasive alternative to open procedures [11,12]. The evolution of percutaneous pedicle screw instrument systems and of expandable tubular retractor systems have contributed much to the popularization of minimally invasive transforaminal lumbar interbody fusion (MITLIF) [11,12].…”

“…Because percutaneous pedicle screw insertion is performed under fluoroscopic guidance using different landmarks [11,12], we hypothesized that some demographic and surgical factors could predict the inaccurate placement of pedicle screws. Accordingly, this study was undertaken to determine the incidence of pedicle screw misplacement during MITLIF and to identify relevant risk factors.…”

Role of Minimally Invasive Spine Surgery in Adults with Degenerative Lumbar Scoliosis: A Narrative Review

“…The primary change has a sharp learning curve; but there are numerous basic concepts which can help the surgeon in safe application of the Jamshidi needle into a thoracic or lumbar pedicle [101].…”

“…The paraspinal muscle dissection implicated in open spine surgery can lead to muscular denervation, augmented intramuscular pressure, ischemia, and necrosis giving rise to muscle atrophy and scarring, and sustained pain and disability [102,103]. There is no available study of high-quality demonstration showing MIS is better than open surgery; but there is a tendency towards MIS options having lower complication rates and morbidity, with negligible soft tissue disturbance, decreased blood loss and danger of transfusion, better cosmetics, less hospital stays, earlier return to work, and therefore diminished general health care prices [101,102,104]. Notwithstanding this, many raised concerns that MIS is related to imperfect results for adult deformity mainly due to significantly reduced visualization with MIS [105] in addition to the increased radiation exposure [105,106].…”