gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Percutaneous pedicle screw placement in thoracic an lumbar spine – results of two centers

Meeting Abstract

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  • K. Seidel - Klinik für Neurochirurgie der Universität Ulm am BKH Günzburg
  • C. Wimmer - Klinik für Wirbelsäulenchirurgie und Skoliosezentrum BHZ Vogtareuth

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMO.10-05

DOI: 10.3205/09dgnc066, URN: urn:nbn:de:0183-09dgnc0668

Published: May 20, 2009

© 2009 Seidel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Minimally invasive or percutaneous pedicle screw placement are now common techniques in spine surgery. In first publications a screw misplacement rates from 6,6% up to 12 % were described. Also extreme medial placements (>6mm) with resulted in a nerve root injuries are published.

Methods: Between 2004 and 2008 in both centers 235 patients (BKH 60, BHZ 175) with mono- or bisegmental spinal pathologies (degenerative, tumor, trauma, infection) underwent a percutaneous instrumentation. All pedicle screws were placed percutaneously via four or six 15 mm incisions under biplanar fluoroscopy. For instrumentation we used the DePuy Expedium™ LIS system. 978 (BKH 254, BHZ 724) pedicle screws were placed between Th 1 and S1. All patients underwent a postoperative CT scan with coronal and sagittal reconstructions.

Results: A total of 978 screws were analysed in 235 patients, and 960 screws were placed without a violation of the pedicle wall. Only 18/978 (1,8%) screws were misplaced. There were only 5 medial breaches of the pedicle wall. Two screws had to be revised because of a new radicular pain. No neurologic deficit resulted. All medial misplacements were found at the level S1. 14 screws were placed laterally without compromising stability. None of them had to be corrected.

Conclusions: Percutaneous pedicle screw placement is a safe procedure in spine surgery. All in all 98,1% of all screws were placed correct. Only 2 (0,2%) had to be revised. Compared to open techniques there is a no higher risk of screw misplacement. The most dangerous level is S1 because of the limitation of the iliac crest and the need of a high angle of the trajectory.