Percutaneous pedicle screw placement with computer-navigated mapping in place of kirschner wires: Clinical article

Thomas J. Gianaris, Gregory M. Helbig, Eric M. Horn

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Object. Percutaneous pedicle screw insertion techniques are commonly used to treat a variety of spinal disorders. Typically, Kirschner (K)-wires are used to guide the insertion of taps and screws during placement since the normal anatomical landmarks are not visualized. The use of K-wires adds risks, such as vascular and nerve injuries as well as increased radiation exposure given the use of fluoroscopy. The authors describe a series of patients who had percutaneous pedicle screws placed using a new computer-assisted navigation technique without the need for K-wires. Methods. Minimally invasive percutaneous pedicle screw placement in the thoracic and lumbar spine was performed in a consecutive series of 15 patients for a variety of spinal pathologies. Intraoperative 3D CT images were obtained and used with a computer-assisted navigation system to insert an awl-tap into each pedicle. The tap location in the pedicle was marked with the navigation software, and the awl-tap was then removed. The navigation system was used to identify each landmark to insert the pedicle screw. Connecting rods were then inserted percutaneously under fluoroscopic guidance. Postoperative CT scans were obtained in each patient to evaluate screw placement. Results. On postprocedure scanning, only 1 screw had a minor lateral and superior breach that was asymptomatic. To date, there have been no hardware failures. Conclusions. Percutaneous pedicle screws can be placed effectively and safely without the use of K-wires.

Original languageEnglish (US)
Pages (from-to)608-613
Number of pages6
JournalJournal of Neurosurgery: Spine
Volume19
Issue number5
DOIs
StatePublished - Nov 1 2013

Keywords

  • Bone screw
  • Neurosurgical procedure
  • Surgical equipment
  • Surgical fixation device
  • Technique

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Neurology

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