Navigated Percutaneous Cervical Pedicle Screw Internal Fixation

Presented at SMISS Annual Forum 2018
By John Peloza MD
With Meghan Cingrani ,

Disclosures: John Peloza MD B; Spinewave, Spineology, RTI Surgical, Camber. D; Paradigm Spine, 4Web Medical. F; Depuy Synthes Meghan Cingrani None,

Introduction:

Open posterior cervical procedures, especially with fusion and internal fixation, are traditionally associated with significant post-operative pain and loss of paracervical muscle function secondary to muscular necrosis. Improvements in technology and surgeon skill have allowed the development of a novel surgical technique: cervical percutaneous pedicle screw instrumentation utilizing minimally invasive surgical (MIS) techniques with intraoperative 3-D imaging and computer navigation. This study follows one surgeon’s initial experience with this novel technique.

Aims/Objectives:

This study follows one surgeon’s initial experience with this novel technique.

Methods:

A retrospective review of prospectively collected data was performed on 21 consecutive navigated posterior cervical pedicle screw instrumentation cases. All patients had Intra-operative 2D and 3D intraoperative imaging, and serial post-operative x-rays. All have been prospectively followed with Visual Analog Scale (VAS) neck, VAS arm, Neck Disability Index (NDI) scores collected preoperatively and at each postoperative visit. Additionally, procedure related adverse events are reported and monitored.

Results:

From January 2015 to May 2018, 21 consecutive patients who underwent navigated, MIS posterior cervical instrumentation were prospectively followed. There were 12 males and 9 females with an average age of 62.6 (men 63.25, women 61.7). 14 of 21 patients had undergone at least one previous cervical fusion procedure with a total of 21 previous cervical surgeries. On the day of the pedicle screw instrumentation, 9 underwent anterior cervical fusion prior to the posterior procedure. The remaining 12 had only posterior procedures. On average, 4 levels were included in the construct, most commonly C3-C7. Pre-operative scores in all patients (n=21) average as follows: NDI 25.86/50, VAS Neck 65.6/100, VAS arm 41.3/100. Currently, 6-month post-op scores are available on 16 of 21 patients: NDI average 14.16/50, VAS Neck 24.7/100, and VAS Arm 18.5/100; decreases of 43.78%, 59.64%, and 45.77% respectively. 2 of 21 patients had procedure related complications that resulted in a return to the operating room. 1- Left C5 screw malposition, and 1- C7 fracture resulting in bilateral screw loosening. Both patients underwent successful revision with no additional morbidity.

Conclusions:

This surgeon’s cohort illustrates that minimally invasive percutaneous posterior cervical pedicle screw instrumentation, when performed with image guided navigation is safe and effective at reducing pain and disability. It is a useful technique to minimize injury to normal tissues for many cervical spinal pathologies that require supplemental fixation.