gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Image guided percutaneous transpedicular fixation of the thoracolumbar region. Technique and results

Navigierte perkutane transpedikuläre Fixierung des thorakolumbalen Übergangs. Operative Technik und Ergebnisse

Meeting Abstract

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  • corresponding author V.I. Vougioukas - Abteilung Allgemeine Neurochirurgie, Universitätsklinikum Freiburg
  • U. Hubbe - Abteilung Allgemeine Neurochirurgie, Universitätsklinikum Freiburg

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSA.10.02

The electronic version of this article is the complete one and can be found online at:

Published: April 11, 2007

© 2007 Vougioukas et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The proximity of thoracic pedicles to the spinal cord and neurovascular structures as well as the anatomic variability of the thoracolumbar region has prompted a multitude of efforts to obtain proper screw placement. The aim of this study was to evaluate the feasibility and efficacy of navigated percutaneous screw fixation of the thoracolumbar region.

Methods: Navigated percutaneous screw fixation of the thoracolumbar spine was performed in 21 patients with osteoporotic fractures and 12 patients with monosegmental spondylodiscitis. A total of 132 screws (Sextant, Medtronic) were inserted. A Stryker navigation system and the Iso-C-3D C-arm were used for image guidance. Postoperative computerized tomographic images were obtained in all cases to analyze the position of each screw in respect to the pedicle, the spinal canal and the vertebral body. In addition, screw convergence angles were calculated for each instrumented level. Follow-up ranged between 6 and 18 months.

Results: There was no additional morbidity associated with screw insertion. In a single case, one rod couldn't be inserted properly percutanously and the operation was converted to a partially “open” procedure. All screws were placed entirely within the pedicle and vertebral body without damage to neural foramina, pleura and vascular structures. We did not observe any screw breakage. Total operation time (45±32) was prolonged due to data acquisition for 15±6 minutes. In 2 cases, a second data set had to be acquired because of poor image quality. Finally intraoperative blood loss was 20±50ml.

Conclusions: Thoracolumbar instabilities can be treated adequately and safely using navigated percutaneous screw fixation. Despite the additional time needed for intraoperative data acquisition, total operation time was shorter and intraoperative blood loss was minimized compared to a standard open procedure. Furthermore, the use of computer-aided navigation alleviates the need for perioperative fluoroscopic images. Nevertheless, the technical complexity of data acquisition requires a learning curve that is far from being negligible.