Navigated minimally invasive facet fusion during percutaneous lumbar pedicle screw insertion: Technical note |
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| Institution: | 1. Department of Neurosurgery, University of California San Francisco, United States;2. Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, China;1. Department of Neurology, University Medicine Rostock, Germany;2. Department of Diagnostic and Interventional Radiology, University Medicine Rostock, Germany;1. Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA;2. Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA;3. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA;4. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA;5. Rocky Mountain Scoliosis and Spine, Denver, CO, USA;6. Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA;7. San Diego Center for Spinal Disorders, La Jolla, CA, USA;8. Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA;9. Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA;10. Department of Orthopedic Surgery, University of California, Davis, Davis, CA, USA;11. Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA;12. Department of Orthopedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA;13. Rocky Mountain Scoliosis and Spine, Denver, CO, USA;14. Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA |
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| Abstract: | ObjectiveMinimally invasive surgery (MIS), or percutaneous, lumbar pedicle screw placement is commonly done, but the percutaneous nature of this makes posterior arthrodesis extremely difficult. Many times, surgeons will simply forego posterior arthrodesis, place posterior pedicle screws, and rely only on the interbody area for arthrodesis. We describe our technique of adding facet arthrodesis via the same corridor through which the pedicle screw is inserted with minimal addition of time or steps.MethodsWe demonstrate our technique of how we use navigation and tubular retractors to perform posterior facet arthrodesis during percutaneous pedicle screw placement. We illustrate this technique with a case of a patient with scoliosis, intraoperative photos, and an illustrative video. We also show an intraoperative computed tomography image to help visualize the arthrodesis surfaces. With this technique, we show how there are a few additional steps that are not very time consuming to add posterior arthrodesis.ResultsMIS facet fusion can be performed in a relatively straightforward manner during percutaneous pedicle fixation without significant addition of intraoperative time or steps.ConclusionsIt is possible to add posterior arthrodesis to percutaneous lumbar pedicle screw fusion with few added steps and minimal addition of time using navigation and MIS tubular retractors. |
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| Keywords: | Minimally invasive MIS Facet fusion Percutaneous screw Lumbar pedicle screw insertion |
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