Beckman Joshua M, Murray Gisela, Bach Konrad, Deukmedjian Armen, Uribe Juan S
University of South Florida, Tampa, Florida.
Oper Neurosurg. 2015 Dec 1;11(4):530-536. doi: 10.1227/NEU.0000000000000977.
Multiple methods for minimally invasive (MIS) thoracic and lumbar pedicle screw placement exist. The guide wire is almost universally used for most insertion techniques; however, its use is not without complication and potentially prolongs surgical procedures.
To evaluate the safety of percutaneous MIS guide wire-less pedicle screw placement in the thoracic and lumbar spine at a single institution over a 3-year experience.
Forty-one patients who underwent posterior instrumentation with 110 transpedicular MIS thoracic and lumbar screws by a single surgeon from 2011 to 2014 were analyzed. The mean age was 63 years at the time of surgery. Etiological diagnoses were adult spinal deformity, trauma, spondylosis/spondylolisthesis, and other spinal diseases. Pedicle screws were inserted with the use of a guide wire-free technique in which anatomy-specific entry sites and fluoroscopic landmarks were used to guide the surgeon. A square, sharp-tipped pedicle screw was carefully advanced under biplanar fluoroscopic image (anteroposterior and lateral) down the pedicle into the body. No tapping or any type of electromonitoring was performed. An independent spine surgeon using medical records and thoracic/lumbar computed tomography taken during the postoperative period reviewed all patients.
The number of the screws inserted at each level was as follows: total, 110; thoracic, 30; and lumbar, 80. All screws were evaluated by computed tomography to assess screw position. Seven screws (6.3%) were inserted with moderate cortical perforation, including 3 screws (2.7%) that violated the medial wall. There were no neurological, vascular, or visceral complications with up to 3 years of follow-up.
The percutaneous MIS guide wire-less technique of lumbar and thoracic pedicle screw placement performed using a biplanar fluoroscopic guidance in a stepwise, consistent manner is an accurate, safe, and reproducible method of insertion to treat a variety of spinal disorders.
存在多种用于微创（MIS）胸腰椎椎弓根螺钉置入的方法。导丝几乎普遍用于大多数置入技术；然而，其使用并非没有并发症，且可能延长手术时间。
评估在一家机构3年经验中，经皮微创无导丝椎弓根螺钉置入胸腰椎的安全性。
分析了2011年至2014年由一名外科医生对41例患者进行的110枚经椎弓根微创胸腰椎螺钉后路内固定手术。手术时平均年龄为63岁。病因诊断为成人脊柱畸形、创伤、脊柱退变/椎体滑脱及其他脊柱疾病。使用无导丝技术置入椎弓根螺钉，其中利用特定解剖学入路点和透视标志引导外科医生。在双平面透视图像（前后位和侧位）引导下，将方形、尖顶椎弓根螺钉小心地沿椎弓根推进至椎体。未进行攻丝或任何类型的电监测。一名独立的脊柱外科医生使用病历及术后拍摄的胸/腰椎计算机断层扫描对所有患者进行了评估。
各节段置入的螺钉数量如下：总计110枚；胸椎30枚；腰椎80枚。所有螺钉均通过计算机断层扫描评估螺钉位置。7枚螺钉（6.3%）置入时出现中度皮质穿孔，其中3枚螺钉（2.7%）穿透内侧壁。随访长达3年，无神经、血管或内脏并发症。
采用双平面透视引导，以逐步、一致的方式进行经皮微创无导丝胸腰椎椎弓根螺钉置入技术，是治疗各种脊柱疾病准确、安全且可重复的置入方法。
