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J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/a-2479-5742
Original Article

First Experience Using a New Minimally Invasive Screw–Rod System for Completely Percutaneous Pedicle Screw Fixation of the Cervical Spine

Christoph Scholz
1   Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
,
Marc Hohenhaus
1   Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
,
Ulrich Hubbe
1   Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
,
Florian Volz 
1   Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
,
Ralf Watzlawick
1   Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
,
Jürgen Beck
1   Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
,
Jan-Helge Klingler
1   Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
› Author Affiliations Trial Registration Clinical trial registration number: DRKS00032114 (www.drks.de). Date of registration: October 11, 2023.
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Abstract

Background and Study Aim

In contrast to the thoracolumbar spine, where pedicle screws can be inserted via a minimally invasive, percutaneous technique through small skin incisions, all previously available cervical instrumentation systems required a larger midline incision, especially for rod insertion. Screw placement via small incisions reduces the risk of wound healing disorders and blood loss, and patients can be mobilized more quickly and with less pain. In 2022, a cervical, minimally invasive stabilization system became available for the complete percutaneous insertion of both cervical pedicle screws and rods. We report on the first results and experiences with this new technology.

Methods

In this retrospective case series, we included patients with cervical instability treated by minimally invasive percutaneous cervical and upper thoracic spine pedicle screw and rod insertion between August 2022 and August 2023. Intra- and postoperative complications as well as revision surgeries were recorded. The screw position was evaluated by three examiners in the postoperative computed tomography (CT) using the Bredow classification.

Results

Our series includes six male patients (age = 56.9 ± 12.9 years; body mass index [BMI] = 29.8 ± 9.6 kg/m2). The indication for surgery was trauma, tumor, and degenerative stenosis in two patients each. An excellent/good screw position (Bredow 1 and 2) was found in 84.4% of the screws (n = 27/32). None of the screws rated as Bredow 3 (n = 2/32) or Bredow 4 (n = 3/32) resulted in a neurological deficit or radicular pain and none had to be repositioned. No neurologic complication or revision surgery occurred. As a complication not directly related to the surgery technique, one patient died of a pulmonary lung embolism on the seventh postoperative day.

Conclusion

The results of this study indicate that minimally invasive percutaneous implantation of a pedicle screw–rod system is also possible in the cervical spine with sufficient accuracy using intraoperative navigation. However, technical details, possible pitfalls and finally careful patient selection must be taken into account.

Keywords

cervical spine - minimally invasive - navigation - pedicle screws - spinal instability


Publication History

Received: 20 February 2024

Accepted: 19 November 2024

Accepted Manuscript online:
21 November 2024

Article published online:
26 May 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Zhou J, Wang R, Huo X, Xiong W, Kang L, Xue Y. Incidence of surgical site infection after spine surgery: a systematic review and meta-analysis. Spine 2020; 45 (03) 208-216
    Search in Google Scholar
  • 2 O'Toole JE, Eichholz KM, Fessler RG. Minimally invasive approaches to vertebral column and spinal cord tumors. Neurosurg Clin N Am 2006; 17 (04) 491-506
    Search in Google Scholar
  • 3 Nerland US, Jakola AS, Solheim O. et al. Minimally invasive decompression versus open laminectomy for central stenosis of the lumbar spine: pragmatic comparative effectiveness study. BMJ 2015; 350: h1603
    Search in Google Scholar
  • 4 Pokorny G, Amaral R, Marcelino F. et al. Minimally invasive versus open surgery for degenerative lumbar pathologies: a systematic review and meta-analysis. Eur Spine J 2022; 31 (10) 2502-2526
    Search in Google Scholar
  • 5 Ishii K, Funao H, Isogai N. et al. The history and development of the percutaneous pedicle screw (PPS) system. Medicina (Kaunas) 2022; 58 (08) 1064
    Search in Google Scholar
  • 6 Carlson BB, Saville P, Dowdell J. et al. Restoration of lumbar lordosis after minimally invasive transforaminal lumbar interbody fusion: a systematic review. Spine J 2019; 19 (05) 951-958
    Search in Google Scholar
  • 7 Richter M, Mattes T, Cakir B. Computer-assisted posterior instrumentation of the cervical and cervico-thoracic spine. Eur Spine J 2004; 13 (01) 50-59
    Search in Google Scholar
  • 8 Kothe R, Richter M. Relevance of spinal navigation in reconstructive surgery of the cervical spine [in German]. Orthopade 2018; 47 (06) 518-525
    Search in Google Scholar
  • 9 Bredow J, Beyer F, Oppermann J. et al. A novel classification of screw placement accuracy in the cervical spine. Technol Health Care 2016; 24 (06) 919-925
    Search in Google Scholar
  • 10 Kendall MG, Smith BB. The problem of $m$ rankings. Ann Math Stat 1939; 10 (03) 275-287
    Search in Google Scholar
  • 11 Hallgren KA. Computing inter-rater reliability for observational data: an overview and tutorial. Tutor Quant Methods Psychol 2012; 8 (01) 23-34
    Search in Google Scholar
  • 12 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33 (01) 159-174
    Search in Google Scholar
  • 13 Karaikovic EE, Daubs MD, Madsen RW, Gaines Jr RW. Morphologic characteristics of human cervical pedicles. Spine 1997; 22 (05) 493-500
    Search in Google Scholar
  • 14 Schmidt R, Wilke HJ, Claes L, Puhl W, Richter M. Pedicle screws enhance primary stability in multilevel cervical corpectomies: biomechanical in vitro comparison of different implants including constrained and nonconstrained posterior instumentations. Spine 2003; 28 (16) 1821-1828
    Search in Google Scholar
  • 15 Coric D, Rossi VJ, Peloza J, Kim PK, Adamson TE. Percutaneous, navigated minimally invasive posterior cervical pedicle screw fixation. Int J Spine Surg 2020; 14 (s3): S14-S21
    Search in Google Scholar
  • 16 Coric D, Rossi V. Percutaneous posterior cervical pedicle instrumentation (C1 to C7) with navigation guidance: early series of 27 cases. Global Spine J 2022; 12 (2_suppl): 27S-33S
    Search in Google Scholar
  • 17 Klingler JH, Ille S. Minimalinvasive Wirbelsäulenchirurgie und aufkommende neue Techniken: Navigation, Robotik und augmented reality. [in German]. Wirbels 2023; 07 (03) 139-152
    Search in Google Scholar
  • 18 Lee GYF, Massicotte EM, Rampersaud YR. Clinical accuracy of cervicothoracic pedicle screw placement: a comparison of the “open” lamino-foraminotomy and computer-assisted techniques. J Spinal Disord Tech 2007; 20 (01) 25-32
    Search in Google Scholar
  • 19 Abumi K, Shono Y, Ito M, Taneichi H, Kotani Y, Kaneda K. Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine 2000; 25 (08) 962-969
    Search in Google Scholar
  • 20 Takahashi J, Shono Y, Nakamura I. et al. Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis. Eur Spine J 2007; 16 (04) 485-494
    Search in Google Scholar
  • 21 Ito Y, Sugimoto Y, Tomioka M, Hasegawa Y, Nakago K, Yagata Y. Clinical accuracy of 3D fluoroscopy-assisted cervical pedicle screw insertion. J Neurosurg Spine 2008; 9 (05) 450-453
    Search in Google Scholar
  • 22 Lee CH, Lee J, Kang JD. et al. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes. J Neurosurg Spine 2015; 22 (06) 589-595
    Search in Google Scholar
  • 23 Liu T, Xu W, Cheng T, Yang HL. Anterior versus posterior surgery for multilevel cervical myelopathy, which one is better? A systematic review. Eur Spine J 2011; 20 (02) 224-235
    Search in Google Scholar