Three-dimensional image-guided placement of percutaneous pedicle screws without the use of biplanar fluoroscopy or Kirschner wires: technical note

Abstract

Background: Percutaneous pedicle screws are commonly used in minimally invasive spinal procedures. Traditional techniques of percutaneous pedicle screw placement have employed the use of multiplanar fluoroscopy and Kirschner wires (K-wires). The use of multiplanar fluoroscopy for the placement of percutaneous pedicle screws likely increases radiation exposure to the surgeon when compared to open techniques. K-wires can break or become bent during the procedure, making it difficult to insert and remove instrumentation over them. Additionally, there is also a risk of visceral or vascular injury with the use of K-wires. The authors present a novel method of percutaneous pedicle screw placement utilizing three-dimensional (3D) fluoroscopy-based image guidance in which K-wires are not used and there is minimal to no radiation exposure to the surgeon and operating room staff.

Methods: Thirty-six screws were placed in 15 patients using this technique. An independent radiologist graded screw placement using computed tomographic (CT) scans and the breach rate of the percutaneous pedicle screws was compared to the breach rate of 33 pedicle screws placed contralaterally using the mini-open technique.

Results: No bony breach was noted by any screw in either group and no complications occurred in this study as a result of screw placement.

Conclusions: Percutaneous pedicle screws can be placed accurately and safely using 3D image guidance without the use of K-wires. Little to no radiation exposure to the surgeon or OR staff occurs with this technique. No complications occurred in this study as a result of screw placement or image guidance.