A Novel, Single Step Technique to Percutaneously Insert Lumbar Pedicle Screws Significantly Reduces Surgical Time and Radiation Exposure to the Patient and the Surgeon
Presented at SMISS Annual Forum 2018
By Steven DeLuca DO, MS
With William Zuke MD, Adam Wright-Chisem BA,
Disclosures: Steven DeLuca DO, MS B; Premia Spine, Spine Wave. William Zuke MD None, Adam Wright-Chisem BA None,
There are advantages to performing lumbar spinal decompression and pedicle screw instrumentation using minimally invasive surgical techniques. Disadvantages of current minimally invasive operative techniques include dependence on intraoperative fluoroscopy for placement of pedicle screws. A common technique to place percutaneous pedicle screws uses biplanar fluoroscopy which carries radiation exposure risk to the patient and the surgeon. Computer assisted navigation and CT guidance may reduce radiation exposure to the surgeon but increases radiation exposure to the patient when compared to traditional fluoroscopy. These technologies add significant expense and operative time onto the surgical procedure.
The objective of this study is to compare screw insertion speed and radiation exposure to the surgeon and the patient utilizing 4 different minimally invasive pedicle screw insertion techniques using biplanar fluoroscopy.
From January 2017 to January 2018, 182 pedicle screws in 33 patients were inserted by a single surgeon using one of 4 different minimally invasive pedicle screw insertion techniques using biplanar fluoroscopy. The techniques were: traditional jamshedi, novel tapshedi, K-wireless, and novel direct screw insertion. Screw insertion time and fluoroscopy time were recorded for each screw inserted. Radiation exposure to the surgeon and the patient was calculated for each technique. All screws were tested for accuracy using standard neuromonitoring with a minimal threshold of 25 milliamperes (mA).
The average screw insertion times were as follows: 204 seconds using the jamshedi, 166 seconds using the tapshedi, 160 seconds using the K-wireless, and 84 seconds using the direct screw insertion. The average radiation exposure time for the jamshedi was 14.1 seconds, 14.2 seconds for the tapshedi, 12 seconds for the K-wireless and 9.9 seconds for the direct screw insertion. The direct screw insertion technique was at least twice as fast as the other 3 techniques. The radiation exposure was reduced by 30 percent using the direct screw technique compared to the jamshedi and tapshedi and by 18 percent compared to the K-wireless. Only 1 screw tested below threshold (K-wireless, 9mA).
This current study demonstrates the novel technique of fluoroscopic guided insertion of pedicle screws using a direct screw insertion technique is safe, accurate and efficient. This technique significantly reduced screw insertion and fluoroscopy time as well as reduced radiation exposure to the patient and the surgeon.