gms | German Medical Science

Objective: The aim of the prospective study was to examine the complication rate of percutaneous instrumented thoracic and lumbar spine fusion technique. In the literature there exists no prospective study about this new technique.

Methods: From 2005 to 2010, 658 patients (366 female / 292 male) were treated with the new instrumentation. All patients were treated with mono- or multilevel percutaneous instrumentation and with an anterior or posterior minimally invasive interbody fusion or with a minimally invasive posterolateral fusion. Indication for surgery was DDD, spondylolisthesis, trauma and infection. The mean age at operation was 52 years (range from 18 to 89). For instrumentation we used the DePuy ExpediumTM LIS system. 3,392 pedicle screws were placed between Th 1 and S1. 235 patients underwent a postoperative CT scan with coronal and sagittal reconstructions.

Results: The mean follow-up was 22 months (3–48 months). There was none infection or wound problems. There were also no neurologic complications. In ten cases we found a misplacement of pedicle screw medial outside of the pedicle. In four cases a revision surgery was necessary, in cause of radicular pain. 16 screws perforated the lateral pedicle wall without compromise of stability. In one case we a found a broken screw at S1, no broken rod. In six cases we saw radiolucent lines around the screw after poster fusion alone without clinical evidence. In three cases we found degeneration in the adjacent segment. In these cases a revision surgery was necessary. The fusion-rate after 12 months was about 85%. Two cases had anterior revision surgery after a mini open PLIF procedure in cause of a pseudarthrosis. In six cases the instrumentation was removed percutaneously after a solid fusion or fracture healing.

Conclusions: Percutaneous pedicle screw placement is a safe procedure in spine surgery. All in all 3,369 (99,9%) of all screws were placed correctly. Only 4 (0.001%) screws had to be revised. Compared to open and free hand technique there is a no higher risk of screw misplacement. Through the minimal tissues damage, the rate of wound complications and infections is much lower than in open procedures. There were only 5/658 (0.008%) cases that needed a revision surgery because of pseudarthrosis or ALD. This data suggest, that percutaneous instrumented fusion is a feasible and safe procedure compared to open techniques all kinds of complications are much below compared existing studies about open techniques.