Minimally Invasive Percutaneous Transpedicular Screw Fixation: Pros and Cons

Introduction The standard techniques for decompression, fixation, and fusion for various types of spinal disorders are well known. With the introduction of specific instrumentations, new alternative and minimally invasive techniques gain popularity, which in regard to clinical outcome and efficacy are comparable to standard approaches and even surpass them in some cases.

Aim The aim of this study is to assess the technical possibilities for percutaneous transpedicular screw fixation in treating thoracolumbar spine pathology.

Material and methods For the period April 2013 to June 2015, 116 patients were operated in the Department of Neurosurgery, University Hospital Pirogov, using a percutaneous transpedicular screw fixation, alone or in combination with decompression and fusion.

Results In our series, we included 59 patients with vertebral fractures and 57 patients with other spine disorders (degenerative, tumors, and infection) located in the thoracolumbar spine performing screw fixation in two to six vertebral levels. In all cases, using the different capabilities of the instruments for compression, distraction, reclination, and derotation, we achieved stability of the segment and satisfactory correction of the spinal deformity present. We did not observe any technical difficulties. Clinical and imaging follow-up demonstrated excellent short-term results and lack of method-associated complications. The follow-up of the first patients in our series is presently more than 2 years, which also suggests good long-term results.

Conclusion Perioperative advantages of the minimally invasive percutaneous technique incline toward reduction of the iatrogenic intraoperative tissue trauma, thus minimizing the blood loss and postoperative pain, and shortening the period of hospital stay of the patients. In revision surgery and surgery of overweight patients, minimally invasive approach allows an adequate exposure and low level of complications. Clinical outcome and imaging follow-up are comparable with the conventional open operative techniques. Disadvantages of minimally invasive surgeries include the relatively long learning curve and increased time of intraoperative fluoroscopy and radiation exposure.

Keywords minimally invasive; screw fixation; percutaneous; spine