Neurosurgical Department, Spine Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Spine Unit, Orthopedic Department, Hospital Español de Mendoza, Mendoza, Argentina.
World Neurosurg. 2021 May;149:15-25. doi: 10.1016/j.wneu.2021.01.149. Epub 2021 Feb 5.
Two-dimensional fluoroscopy-guided percutaneous pedicle screw placement is currently the most widely applied instrumentation for minimally invasive treatment of spinal injuries requiring stabilization. Although this technique has advantages over open instrumentation, it also presents new challenges and specific complications. The objective of this study was to provide recommendations developed from the experience of several spinal surgeons at different minimally invasive spine surgery reference centers to solve specific problems and prevent complications during the learning curve of this technique.
An AO Spine Latin America minimally invasive spine surgery study group analyzed the most frequent complications and challenges occurring during the placement of >14,000 two-dimensional fluoroscopy-guided percutaneous pedicle screws at different centers over 15 years. Twenty tips considered most relevant to performing this technique, excluding problems directly related to specific brands of instruments, were presented.
The 20 tips included the following: (1) positioning; (2) clean and painless; (3) fewer x-rays; (4) check the clock; (5) beveled tip; (6) transverse-rib-pedicle; (7) double Jamshidi; (8) hammer the Kirschner wire; (9) bent tip; (10) too loose, too tight; (11) new trajectory; (12) manual control; (13) start over; (14) Kirschner wire first; (15) adhesive drape control; (16) bend the rod; (17) lower rods; (18) freehand inner; (19) posterior fusion; (20) revision.
Implementation of these tips might improve performance of this technique and reduce the complications related to percutaneous pedicle screw placement.
二维透视引导经皮椎弓根螺钉固定术目前是微创治疗需要稳定的脊柱损伤最广泛应用的器械。虽然该技术优于开放式器械，但也带来了新的挑战和特定的并发症。本研究的目的是提供一些建议，这些建议是由不同微创脊柱手术参考中心的几位脊柱外科医生的经验总结而来，旨在解决该技术学习曲线期间的具体问题并预防并发症。
AO Spine Latin America 微创脊柱外科研究小组分析了在 15 年期间不同中心超过 14000 例二维透视引导经皮椎弓根螺钉置入术中最常见的并发症和挑战。本研究提出了 20 条被认为与执行该技术最相关的技巧，不包括与特定器械品牌直接相关的问题。
这 20 条技巧包括：（1）定位；（2）清洁无痛；（3）减少 X 射线；（4）核对时钟；（5）斜角尖端；（6）横肋-椎弓根；（7）双 Jamshidi 针；（8）敲击克氏针；（9）弯曲尖端；（10）太松，太紧；（11）新轨迹；（12）手动控制；（13）重新开始；（14）首先使用克氏针；（15）粘性手术巾控制；（16）弯曲棒；（17）降低棒；（18）徒手内固定；（19）后路融合；（20）翻修。
实施这些技巧可能会提高该技术的性能并减少与经皮椎弓根螺钉置入相关的并发症。
