Superior segment facet joint violation and cortical violation after minimally invasive pedicle screw placement

Knox, Jeffrey B.; Dai, Joseph M.; Orchowski, Joseph

doi:10.1016/j.spinee.2011.01.024

Cited by 49 publications

(40 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%

“…In a clinical series of 150 percutaneously placed screws, Nakashima et al 12 identified that 12% of screws were "exposed" (defined as < 50% outside the pedicle) and 3.3% of screws were perforated (defined as > 50% screw diameter outside the pedicle). Knox et al 8 reported a very low cortical violation rate of 2.5% in their series on pa- tients undergoing MIS transforaminal lumbar interbody fusion (TLIF) patients. A more recent prospective study of spinal fractures reported good or excellent placement for 98% of 502 pedicle screws placed using fluoroscopic guidance.…”

Section: Pedicle Wall Breachesmentioning

confidence: 99%

“…Knox et al 8 had an incidence of 11.5% of superior facet violation using percutaneous techniques. However, in a comparison of open versus percutaneous cases, other authors have found a higher incidence of both over facet violation and high-grade facet violation in the percutaneous cases.…”

mentioning

confidence: 99%

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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%

Section: Pedicle Wall Breachesmentioning

confidence: 99%

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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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show abstract

“…Few studies analyzed progression of degenerative changes interesting transfixed joints [11], while it's well known that pedicle screw misplacement could lead to cartilage damage and subsequent ZJ ankylosis [12,13]. The absence of anatomical landmarks makes the pedicle screw entry point identification in percutaneous way strictly dependent to fluoroscopic images.…”

Section: Introductionmentioning

confidence: 99%

“…The absence of anatomical landmarks makes the pedicle screw entry point identification in percutaneous way strictly dependent to fluoroscopic images. Screw trajectory too medial or deeper toolip insertion can lead to impingement between implant and joint space with consequent zigoapophyseal ankylosis [13].…”

Section: Introductionmentioning

confidence: 99%