Blume Christian, Schmidt Tobias Philip, Mueller Christian-Andreas, Romagna Alexander, Pishnamaz Miguel, Clusmann Hans, Bertram Ulf
Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany.
Department of Neurosurgery, Muenchen Klinik Bogenhausen, Munich, Germany.
J Spine Surg. 2025 Mar 24;11(1):96-103. doi: 10.21037/jss-24-45. Epub 2024 Dec 16.
Since its introduction, placement of cervical pedicle screws (CPS) has been considered a procedure with a very high-risk profile. Minimally invasive CPS placement was not even considered at all. However, as surgical techniques and image guided intra-operative navigation have been refined over the last decade, navigated CPS placement has become a standard procedure in well-established spine centers. Currently, the first off-the-shelf percutaneous CPS placement platforms are becoming available. The aim of this study is to assess feasibility and accuracy of an minimally invasive surgery (MIS) CPS fixation system in a pilot series.
Between January and July 2023, we treated a cohort of ten patients using a new cervical MIS platform. Forty pedicle screws were inserted percutaneously in the c-spine using intra-operative computed tomography (CT) guided navigation and retrospectively analysed for accuracy using a modified Gertzbein & Robbins (G&R) classification. Adverse events and other patient-related data were also documented.
Ninety percent of all screws were placed accurately (80% on perfect trajectory, 10% showed minor perforations). Another 10% (four screws) caused pedicle wall breaches between 2 and 4 mm, but were not revised, since misplacement was not associated with neurological deficit or inferior biomechanics. One patient experienced neurological deterioration, but not associated with screw misplacement. The transverse foramen was breached twice, however not endangering the vertebral arteries.
In this pilot series MIS CPS placement yielded accurate placement rates comparable to open surgical approaches reported in the literature. Hence, MIS CPS placement appears to be a feasible and safe procedure in selected cases.
自颈椎椎弓根螺钉（CPS）问世以来，其置入一直被认为是一种风险极高的手术。微创CPS置入甚至根本未被考虑过。然而，在过去十年中，随着手术技术和术中影像引导导航技术的不断完善，导航下CPS置入已成为成熟脊柱中心的标准手术。目前，首批现成的经皮CPS置入平台已面市。本研究的目的是在一个试点系列中评估一种微创手术（MIS）CPS固定系统的可行性和准确性。
2023年1月至7月期间，我们使用一种新的颈椎MIS平台治疗了一组10例患者。在术中计算机断层扫描（CT）引导导航下经皮在颈椎置入40枚椎弓根螺钉，并使用改良的Gertzbein & Robbins（G&R）分类法对准确性进行回顾性分析。还记录了不良事件和其他与患者相关的数据。
所有螺钉中有90%置入准确（80%走行完美，10%有轻微穿孔）。另外10%（4枚螺钉）导致椎弓根壁破裂2至4毫米，但未进行翻修，因为错位与神经功能缺损或生物力学不佳无关。1例患者出现神经功能恶化，但与螺钉错位无关。横突孔有两次被穿透，但未危及椎动脉。
在这个试点系列中，MIS CPS置入的准确置入率与文献报道的开放手术方法相当。因此，在特定病例中，MIS CPS置入似乎是一种可行且安全的手术。
