Percutaneous “K-wireless” pedicle screw fixation technique: an evaluation of the initial experience of 100 screws with assessment of accuracy, radiation exposure, and procedure time

Spitz, Steven; Sandhu, Faheem A.; Voyadzis, Jean-Marc

doi:10.3171/2014.11.spine14181

Cited by 45 publications

(41 citation statements)

References 51 publications

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“…However, K-wires are associated with the added morbidity of potential violation of the retroperitoneum and malfunctions such as bending, breaking, and decannulating. 19,20 Recently, a ''K-wireless'' percutaneous pedicle screw placement technique was published by Spitz et al 21 that uses intraoperative fluoroscopy for localization. This method is technically feasible and provides a safe alternative to the use of K-wires.…”

Section: Introductionmentioning

confidence: 99%

“…This method is technically feasible and provides a safe alternative to the use of K-wires. 21 At our institution, we have modified the Spitz technique by using intraoperative image-guided stereotactic navigation rather than fluoroscopy for pedicle screw placement to provide increased speed and precision, all while reducing the radiation exposure of operating personnel. Information on the K-wireless technique is limited, and, to our knowledge, using intraoperative image-guided stereotactic navigation has not been reported.…”

Section: Introductionmentioning

confidence: 99%

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Minimally Invasive, Stereotactic, Wireless, Percutaneous Pedicle Screw Placement in the Lumbar Spine: Accuracy Rates With 182 Consecutive Screws

et al. 2018

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Background: Standard fluoroscopic navigation and stereotactic computed tomography-guided lumbar pedicle screw instrumentation traditionally relied on the placement of Kirshner wires (K-wires) to ensure accurate screw placement. The use of K-wires, however, is associated with a risk of morbidity due to potential ventral displacement into the retroperitoneum. We report our experience using a computer image-guided, wireless method for pedicle screw placement. We hypothesize that minimally invasive, wireless pedicle screw placement is as accurate and safe as the traditional technique using K-wires while decreasing operative time and avoiding potential complications associated with K-wires.Methods: We conducted a retrospective review of 42 consecutive patients who underwent a stereotactic-guided, wireless lumbar pedicle screw placement. All screws were placed to provide fixation to a variety of interbody fusion constructs including anterior lumbar interbody fusion, lateral interbody fusion, and transforaminal lumbar interbody fusion. The procedures were performed using the O-arm intraoperative imaging system with StealthStation navigation (Medtronic, Memphis, TN) and Medtronic navigated instrumentation. After placing a percutaneous navigation frame into the posterior superior iliac spine or onto an adjacent spinous process, an intraoperative O-arm image was obtained to allow subsequent StealthStation navigation. Para-median incisions were selected to allow precise percutaneous access to the target pedicles. The pedicles were cannulated using either a stereotactic drill or a novel awl-tipped tap along with a low-speed/high-torque power driver. The initial trajectory into the pedicle was recorded on the Medtronic StealthStation prior to removal of the drill or awl-tap, creating a ''virtual'' K-wire rather than inserting an actual Kwire to allow subsequent tapping and screw insertion. Accurate screw placement is achieved by following the virtual path as an exact computer-aided design model of the screw traversing the pedicle is projected onto the display and by using audible and tactile feedback. A second O-arm scan was obtained to confirm accuracy of screw placement.Results: A total of 20 women and 22 men (average age ¼ 56 years) underwent a total of 182 pedicle screw placements using the stereotactic, wireless technique. The total breach rate was 9.9%, with a clinically significant breach rate of 0% (defined as .2 mm medial breach or .4 mm lateral breach) and a clinical complication rate of 0%.Conclusions: Wireless, percutaneous placement of lumbar pedicle screws using computed tomography-guided stereotactic navigation is a safe, reproducible technique with very high accuracy rates. Minimally Invasive Surgery

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Minimally Invasive, Stereotactic, Wireless, Percutaneous Pedicle Screw Placement in the Lumbar Spine: Accuracy Rates With 182 Consecutive Screws

et al. 2018

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“…Several recent reports in patients with spinal trauma, however, have supported the use of minimally invasive techniques in the trauma population 12 13. Furthermore, when compared to open surgery, percutaneous pedicle screw fixation has been associated with significantly reduced intraoperative blood loss, decreased days on a ventilator, decreased ICU length of stay and shorter length of overall hospital stay 9 14…”

Section: Discussionmentioning

confidence: 99%

Percutaneous pedicle screw fixation for an unstable thoracic spine fracture after a traumatic degloving injury

et al. 2015

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SUMMARYUnstable spinal fractures require urgent surgical intervention to relieve compression of the spinal cord, correct spinal deformity, stabilise the spine and prevent further neurological injury. We report the case of a young man with a thoracic chance fracture in the setting of a devastating degloving injury, whose fracture was stabilised using minimally invasive, percutaneous pedicle screw fixation. We discuss the advantages of using a minimally invasive technique for spinal fixation and its role in the treatment of complicated, multisystem trauma patients. BACKGROUND

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“…The concept of pars defect reconstruction involves the consolidation of the isthmus by different osteosynthesis techniques and became an alternative to in situ segmental spinal fusion. 3,24,27 On the other hand, Westacott et al 26 revealed little clinical difference between pars repair and fusion techniques. The advantage of this procedure is preservation of motion over the spondylolytic level in young patients taking into consideration the disc status in Magnetic Resonance Imaging (MRI) finding.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Direct Lumbar Spondylolysis Reconstruction by Bone Graft and Fixation Using Pedicular Screw Rod Laminar Hook Construct

Omran

Ahmed

2019

Egyptian Spine Journal

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Background Data: Lumbar spondylolysis is often managed by conservative methods in most patients. Operative interference is indicated in symptomatic patients not responding to medical treatment or patients with multilevel pars defect. Purpose: To evaluate the clinical, functional, and radiological results of bone graft and pedicular screw fixation and rod laminar hook construct in treatment of lumbar spondylolysis. Study Design: A prospective clinical case cohort study. Patients and Methods: Between October 2017 and January 2019, fifteen patients with symptomatic lumbar spondylolysis not responding to conservative treatment for more than 6 months were treated by reconstruction of pars defect by bone block autografting and fixation using pedicular screw laminar hook construct. The mean follow-up was 9.47±3.07 months. All patients were examined pre-and postoperatively and they were followed up clinically; for measuring their pain scale, Visual Analogue Scale (VAS); functionally, Oswestry Disability Index (ODI); radiologically (pars defect healing). Perioperative outcomes and complications were documented. Results: Clinical, radiological, and functional outcomes were significantly improved. Bony union was evident in all patients (100%). Blood loss, operative time, and hospital stay were reported. Two cases reported complications in this study: misplaced pedicular screw and superficial wound infection. Conclusion: Direct reconstruction of pars defect by bone graft and fixation using pedicular screw rod laminar hook construct is an effective feasible procedure in treating lumbar spondylosis. It preserves lumbar motion and hence may decrease adjacent segment problems. (2019ESJ194)

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Percutaneous “K-wireless” pedicle screw fixation technique: an evaluation of the initial experience of 100 screws with assessment of accuracy, radiation exposure, and procedure time

Cited by 45 publications

References 51 publications

Minimally Invasive, Stereotactic, Wireless, Percutaneous Pedicle Screw Placement in the Lumbar Spine: Accuracy Rates With 182 Consecutive Screws

Minimally Invasive, Stereotactic, Wireless, Percutaneous Pedicle Screw Placement in the Lumbar Spine: Accuracy Rates With 182 Consecutive Screws

Percutaneous pedicle screw fixation for an unstable thoracic spine fracture after a traumatic degloving injury

Outcomes of Direct Lumbar Spondylolysis Reconstruction by Bone Graft and Fixation Using Pedicular Screw Rod Laminar Hook Construct

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