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BMC Musculoskeletal Disorders

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Open Access 01-12-2020 | Research article

Accuracy of pedicle screw insertion for unilateral open transforaminal lumbar interbody fusion: a side-by-side comparison of percutaneous and conventional open techniques in the same patients

Authors: Satoshi Sumiya, Fujiki Numano, Takahisa Ogawa, Toshitaka Yoshii, Atsushi Okawa, Hiromichi Komori

Published in: BMC Musculoskeletal Disorders | Issue 1/2020

Abstract

Background

The aim of the study was to compare the accuracy of percutaneous pedicle screw (PPS) insertion (P-side) with that of conventional open screw insertion (O-side) during unilateral open transforaminal lumbar interbody fusion (TLIF) in the same patients. We also sought to determine the incidence of pedicle screw misplacement and to identify relevant risk factors.

Methods

The study was a retrospective analysis of prospectively collected data for 766 pedicle screws placed in 181 consecutive patients who underwent a unilateral open-TLIF procedure in the lumbosacral spine. Our minimally invasive TLIF was performed by unilateral open freehand insertion of pedicle screws for decompression on one side and PPS on the opposite side. Using this approach, we were able to compare the accuracy of PPS insertion with that of conventional open screw insertion in the same patients. There were 383 PPSs and 383 screws inserted by the open method. The accuracy of screw placement was evaluated on reconstructed computed tomography images obtained postoperatively, and screw misplacement was classified. Potential risk factors for screw misplacement were investigated in three-level mixed-effects logistic regression analysis.

Results

Thirty-four screws (8.9%) were misplaced on the P-side and 37 (9.5%) were misplaced on the O-side; the difference was not statistically significant (P = 0.803). Subclassification analysis revealed minor perforation of 28 screws (7.3%) on the P-side and 32 (8.4%) on the O-side, moderate perforation of 5 screws (1.3%) on the P-side and 4 (1.0%) on the O-side, and severe perforation of 1 screw (0.3%) on each side. Three-level mixed-effects logistic regression analysis identified body mass index as a significant risk factor for screw misplacement on the P-side (odds ratio 1.194, 95% confidence interval 1.066–1.338).

Conclusions

Accuracy of pedicle screw insertion was not significantly different between PPS insertion and conventional open screw insertion in the same patients. Body mass index had a significant influence on the risk of screw misplacement in PPS insertion.

Fan S, Hu Z, Zhao F, Zhao X, Huang Y, Fang X. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. Eur Spine J. 2010;19:316–24. https://doi.org/10.1007/s00586-009-1191-6.CrossRefPubMed

Fan SW, Hu ZJ, Fang XQ, Zhao FD, Huang Y, Yu HJ. Comparison of paraspinal muscle injury in one-level lumbar posterior inter-body fusion: modified minimally invasive and traditional open approaches. Orthop Surg. 2010;2:194–200. https://doi.org/10.1111/j.1757-7861.2010.00086.x.CrossRefPubMedPubMedCentral

Foley KT, Holly LT, Schwender JD. Minimally invasive lumbar fusion. Spine. 2003;28:S26–35. https://doi.org/10.1097/01.BRS.0000076895.52418.5E.CrossRefPubMed

Holly LT, Schwender JD, Rouben DP, Foley KT. Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications. Neurosurg Focus. 2006;20:E6.CrossRef

Kim MC, Chung HT, Cho JL, Kim DJ, Chung NS. Factors affecting the accurate placement of percutaneous pedicle screws during minimally invasive transforaminal lumbar interbody fusion. Eur Spine J. 2011;20:1635–43. https://doi.org/10.1007/s00586-011-1892-5.CrossRefPubMedPubMedCentral

Yoshii T, Hirai T, Yamada T, Sumiya S, Mastumoto R, Kato T, Enomoto M, Inose H, Kawabata S, Shinomiya K, Okawa A. Lumbosacral pedicle screw placement using a fluoroscopic pedicle axis view and a cannulated tapping device. J Orthop Surg Res. 2015;10:79. https://doi.org/10.1186/s13018-015-0225-5.CrossRefPubMedPubMedCentral

Oh HS, Kim JS, Lee SH, Liu WC, Hong SW. Comparison between the accuracy of percutaneous and open pedicle screw fixations in lumbosacral fusion. Spine J. 2013;13:1751–7. https://doi.org/10.1016/j.spinee.2013.03.042.CrossRefPubMed

Ikeuchi H, Ikuta K. Accuracy of pedicle screw insertion in the thoracic and lumbar spine: a comparative study between percutaneous screw insertion and conventional open technique. Arch Orthop Trauma Surg. 2016;136:1195–202. https://doi.org/10.1007/s00402-016-2502-0.CrossRefPubMed

Ravi B, Zahrai A, Rampersaud R. Clinical accuracy of computer-assisted two-dimensional fluoroscopy for the percutaneous placement of lumbosacral pedicle screws. Spine. 2011;36:84–91. https://doi.org/10.1097/BRS.0b013e3181cbfd09.CrossRefPubMed

10.

Holly LT, Foley KT. Three-dimensional fluoroscopy-guided percutaneous thoracolumbar pedicle screw placement. Tech Note J Neurosurg. 2003;99:324–9.

11.

Gelalis ID, Paschos NK, Pakos EE, Politis AN, Arnaoutoglou CM, Karageorgos AC, Ploumis A, Xenakis TA. 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;21:247–55. https://doi.org/10.1007/s00586-011-2011-3.CrossRefPubMed

12.

Karapinar L, Erel N, Ozturk H, Altay T, Kaya A. Pedicle screw placement with a free hand technique in thoracolumbar spine: is it safe? J Spinal Disord Tech. 2008;21:63–7. https://doi.org/10.1097/BSD.0b013e3181453dc6.CrossRefPubMed

13.

Schizas C, Michel J, Kosmopoulos V, Theumann N. Computer tomography assessment of pedicle screw insertion in percutaneous posterior transpedicular stabilization. Eur Spine J. 2007;16:613–7. https://doi.org/10.1007/s00586-006-0221-x.CrossRefPubMed

14.

Yoshida G, Sato K, Kanemura T, Iwase T, Togawa D, Matsuyama Y. Accuracy of percutaneous lumbosacral pedicle screw placement using the oblique fluoroscopic view based on computed tomography evaluations. Asian Spine J. 2016;10:630–8. https://doi.org/10.4184/asj.2016.10.4.630.CrossRefPubMedPubMedCentral

15.

Tian NF, Xu HZ. Image-guided pedicle screw insertion accuracy: a meta-analysis. Int Orthop. 2009;33:895–903. https://doi.org/10.1007/s00264-009-0792-3.CrossRefPubMedPubMedCentral

16.

Shin MH, Ryu KS, Park CK. Accuracy and safety in pedicle screw placement in the thoracic and lumbar spines : comparison study between conventional C-arm fluoroscopy and navigation coupled with O-arm(R) guided methods. J Korean Neurosurg Soc. 2012;52:204–9. https://doi.org/10.3340/jkns.2012.52.3.204.CrossRefPubMedPubMedCentral

17.

Wiesner L, Kothe R, Ruther W. Anatomic evaluation of two different techniques for the percutaneous insertion of pedicle screws in the lumbar spine. Spine. 1999;24:1599–603.CrossRef

18.

Pakzaban P. Modified mini-open Transforaminal lumbar Interbody fusion: description of surgical technique and assessment of free-hand pedicle screw insertion. Spine. 2016;41:E1124–30. https://doi.org/10.1097/BRS.0000000000001510.CrossRefPubMedPubMedCentral

19.

Jutte PC, Castelein RM. Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations. Eur Spine J. 2002;11:594–8. https://doi.org/10.1007/s00586-002-0469-8.CrossRefPubMed

20.

Okuda S, Miyauchi A, Oda T, Haku T, Yamamoto T, Iwasaki M. Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients. J Neuros Spine. 2006;4:304–9. https://doi.org/10.3171/spi.2006.4.4.304.CrossRef

21.

Rivet DJ, Jeck D, Brennan J, Epstein A, Lauryssen C. Clinical outcomes and complications associated with pedicle screw fixation-augmented lumbar interbody fusion. J Neuros Spine. 2004;1:261–6. https://doi.org/10.3171/spi.2004.1.3.0261.CrossRef

22.

Lonstein JE, Denis F, Perra JH, Pinto MR, Smith MD, Winter RB. Complications associated with pedicle screws. J Bone Joint Surg Am. 1999;81:1519–28.CrossRef

23.

Cui G, Wang Y, Kao TH, Zhang Y, Liu Z, Liu B, Li J, Zhang X, Zhu S, Lu N, Mao K, Wang Z, Zhang X, Yuan X, Dong T, Xiao S. Application of intraoperative computed tomography with or without navigation system in surgical correction of spinal deformity: a preliminary result of 59 consecutive human cases. Spine. 2012;37:891–900. https://doi.org/10.1097/BRS.0b013e31823aff81.CrossRefPubMed

24.

Rosen DS, Ferguson SD, Ogden AT, Huo D, Fessler RG. Obesity and self-reported outcome after minimally invasive lumbar spinal fusion surgery. Neurosurgery. 2008;63:956–60; discussion 960. https://doi.org/10.1227/01.NEU.0000313626.23194.3F.CrossRefPubMed

25.

Park SM, Shen F, Kim HJ, Kim H, Chang BS, Lee CK, Yeom JS. How many screws are necessary to be considered an experienced surgeon for freehand placement of thoracolumbar pedicle screws?: analysis using the cumulative summation test for learning curve. World Neurosurg. 2018;118:e550–6. https://doi.org/10.1016/j.wneu.2018.06.236.CrossRefPubMed

Title: Accuracy of pedicle screw insertion for unilateral open transforaminal lumbar interbody fusion: a side-by-side comparison of percutaneous and conventional open techniques in the same patients
Authors: Satoshi Sumiya
Fujiki Numano
Takahisa Ogawa
Toshitaka Yoshii
Atsushi Okawa
Hiromichi Komori
Publication date: 01-12-2020
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2020
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-020-3180-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Accuracy of pedicle screw insertion for unilateral open transforaminal lumbar interbody fusion: a side-by-side comparison of percutaneous and conventional open techniques in the same patients

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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