Single- and Multiple-Segment Percutaneous Pedicle Screw-Rod Fixation: Complications and Bailout Strategies

Abstract

Percutaneous pedicle screw fixation systems have improved significantly since their introduction in 2001. A new surgeon’s learning curve is usually 70 cases when defined by the complication rate and not by a specific time to insertion. An appropriate preoperative assessment is important when considering a percutaneous pedicle screw approach, and high complication rates are linked to patients above the age of 65 and the need for multilevel fixation. A surgeon should be wary of performing surgery at the wrong site; therefore, meticulous documentation should be carried out, and the operative level should be confirmed. During surgery, attention should be paid to positioning the patient and varying the location of the skin incision depending on the patient’s obesity. Penetration of visceral structures and vessels due to guidewire insertion is not an uncommon complication. Anterior penetration of the guidewire by as little as 5 mm can cause significant sympathetic chain dysfunction. Guidewire removal should also be prevented during tapping of the screw hole and removal of the Jamshedi needle. This procedure has a high complication rate in unexperienced hands and should be performed by surgeons after adequate cadaver training. Surgeons should initially attempt only single-level fixations and then later on move to more complex multilevel fixations and deformity corrections.