Assessment of Percutaneous “K-wireless” Pedicle Screw Fixation Technique
Asian Journal of Orthopaedic Research,
Page 20-27
Abstract
Percutaneous spinal pedicle screw fixation is a mini invasive technique initially described by Magerl in 1977 [1] using guide wires. The original technique is decribed with use of k-wires which is frequently associated with breakage or recoil during tapping which can extend operating time in often fragile patients and increase radiation exposure in the medical team. Faced with these challenges, we detail our experience with percutaneous k-wireless pedicle screw fixation.
We carried out a retrospective study from January 2018 to December 2020. We collected K-wireless percutaneous pedicle screw fixation performed between the thoracolumbar hinges including T11 up to L5. The positioning of the screws was judged by a postoperative CT scan with grades ranging from A to D: A = intra-pedicle path or "in out in" extra canal. B = Intra-canal path <2 mm, C = Intra-canal path between 2-4mm, and D = Intra-canal path> 4 mm. The operating time, the exposure dose of irradiation and the complications related to the path of the screws were also noted.
A total of 200 screws in 42 patients were collected. A postoperative CT scan was performed in all our patients. 188 screws were grade A. 9 screws were grade B. 2 screws were grade C without clinical consequences and 1grade D symptomatic by an irritation of the left L5 root having required a surgical resumption and the change of the path of the screw. The average time for screw placement was 5.62 minutes with an average exposure dose of 7.6 +/- 1.2 mRem and an irradiation time of 1.2 minutes.
Results of this study showed that lumbur percutaneous k-wireless pedicule screw fixation under fluoroscopic control is achievable with improved operating time and reduced exposure of the medical team.
Keywords:
- Percutaneous pedicle screw
- K-wireless
- technique.
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References
Sebaaly A, Rikallah M, Riouallon G, Wang Z, Moreau P, Bachour F, et al. Percutaneous fixation of thoracolumbar vertebral fractures. EFORT Open Rev. 2018;3(11):604-613.
Phan K, Rao PJ, Mobbs RJ. Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: Systematic review and meta-analysis of comparative studies. Clin Neurol Neurosurg. 2015;135:85-92.
Furuhata R, Nishida M, Morishita M, Yanagimoto S, Tezuka M, Okada E. Migration of a Kirschner wire into the spinal cord: A case report and literature review. J Spinal Cord Med. 2020;43(2):272- 275.
Mobbs RJ, Raley DA. Complications with K-wire insertion for percutaneous pedicle screws. J Spinal Disord Tech. 2014;27:390–394.
Kwan MK, Chiu CK, Chan CW, Zamani R, Hansen Algenstaedt, N. The use of fluoroscopic guided percutaneous pedicle screws in the upper thoracic spine (T1– T6): is it safe? J Orthop Surg. 2017;25(2):1–8.
Spitz SM, Sandhu FA, Voyadzis JM. 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.J Neurosurg Spine. 2015;22(4):422-31.
Shono Y, Kaneda K, Abumi K, McAfee PC, Cunningham BW. Stability of posterior spinal instrumentation and its effects on adjacent motion segments in the lumbosacral spine. Phila Pa. 1998;23(14):1550-1558.
Dirk H Alander, Shari Cui. Percutaneous pedicle screw stabilization: Surgical technique, fracture reduction, and review of current spine trauma applications. J Am Acad Orthop Surg. 2018;26(7):231- 240.
Voyadzis JM. The learning curve in minimally invasive spine surgery. Semin Spine Surg. 2011;23:9–13.
Mobbs RJ, Raley DA. Complications with K-wire insertion for percutaneous pedicle screws. J Spinal Disord Tech. 2014;27(7):390–394.
Gelalis ID, Paschos NK, Pakos EE, Politis AN, Arnaoutoglou CM, Karageorgos AC, et al: Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J. 2012;21:247–255.
Koichi Murata, Shunsuke Fujibayashi, BungoOtsuki, Takayoshi Shimizu, KazutakaMasamoto, Shuichi Matsuda. Accuracy of fluoroscopic guidance with the coaxial view of the pedicle for percutaneous insertion of lumbar pedicle screws and risk factors for pedicle breach. J Neurosurg Spine. 2020;28:1-8.
Waschke A, Walter J, Duenisch P, Reichart R, Kalff R, Ewald C. CT-navigation versus fluoroscopy-guided placement of pedicle screws at the thoracolumbar spine: single center experience of 4, 500 screws. Eur Spine J. 2013;22(3):654–660.
Saeed S, Ryan J, Blake N, Majdi R, Paul JH. Minimally invasive, stereotactic, wireless, percutaneous pedicle screw placement in the lumbar spine: accuracy rates with 182 consecutive screws. Int J Spine Surg. 2018;12(6):650-658.
Wiesner L, Kothe R, Schulitz KP, Ruther W. Clinical evaluation and computed tomography scan analysis of screw tracts after percutaneous insertion of pedicle screws in the lumbar spine. Spine (Phila Pa 1976). 2000;25(5):615–621.
Shiu-Bii Lien, Nien-HsienLiou, Shing-Sheng Wu. Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine. Eur Spine J. 2007;16(8):1215-22.
Pirateb PM, Jacob Y, Mark T, Colum P, Chun S, Ji M. Accuracy of thoracolumbar pedicle screw insertion based on routine use of intraoperative imaging and navigation. Asian Spine J. 2021;15(4):491-497.
Rampersaud YR, Foley KT, Shen AC, Williams S, Solomito M. Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. Spine (Phila Pa 1976). 2000;25:2637–2645.
Bindal RK, Glaze S, Ognoskie M, Tunner V, Malone R, Ghosh S. Surgeon and patient radiation exposure in minimally invasive transforaminal lumbar interbody fusion. J Neurosurg Spine.2008;9:570–573.
Mroz TE, Abdullah KG, Steinmetz MP, Klineberg EO, Lieberman IH: Radiation exposure to the surgeon during percutaneous pedicle screw placement. J Spinal Disord Tech. 2011;24:264– 267.
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