Percutaneous Pedicle Screw Fixation

Percutaneous pedicle screw fixation is a minimally-invasive surgical technique used to attach stabilizing metal rods to neighboring bones (vertebrae) in your spinal column. The procedure gets its name from the placement, or fixation, of the screws for these rods in structures on the targeted bones called the pedicles.

Background Anatomy

Each of your vertebrae has two main sections: the body and the neural arch. The body of each vertebra helps carry most of the weight pressing down on your spinal column, and also forms of the front wall of your spinal canal. The neural arch is a curved structure that juts back from the body of the bone. It also carries some of the downward load on your spine, and forms the rear and sides of your spinal canal. The pedicles are paired structures on either side of the neural arch that connect the arch to vertebral body.

Basics of the Procedure

At the start of a percutaneous pedicle screw fixation procedure, your surgeon will use live X-ray imagery to locate the pedicles on neighboring vertebrae in your spine. Next, he will make small holes or incisions in your back on both sides of your spinal column, then use these openings to insert small metal rods that run between the vertebrae and are attached to them at each end by screws anchored into the targeted pedicles. In some forms of the procedure, surgeons use wires to guide the proper placement of these pedicle screws. In other forms of the procedure, they use direct images from tiny, flexible cameras called endoscopes. Whichever method your surgeon uses, the goal of the surgery is to stabilize your spine while damaging as little healthy tissue as possible.

Depending on your personal circumstances, your surgeon can use percutaneous pedicle screw fixation on two or more neighboring bones in your spinal column. In many cases, the procedure is performed as part of a larger surgery called spinal fusion, which uses material called a bone graft to encourage the growth of new bone tissue in your spinal column. However, in some cases, your doctor may perform a fixation procedure as a separate surgery.

Benefits of the Procedure

Like all other minimally-invasive procedures, percutaneous pedicle screw fixation can potentially achieve its main surgical goals with relatively minor disruption of muscle and other healthy tissues that surround the site of the procedure. In addition, depending on the specific technique he chooses, your surgeon may be able to further minimize any potential tissue damage by using the same small incisions created for pedicle fixation in order to perform an accompanying spinal fusion. When used apart from a fusion procedure, percutaneous fixation can help your surgeon stabilize your spine in the aftermath of certain forms of spinal bone fracture.

Risks of the Procedure

Not all doctors agree on the minimally-invasive benefits of percutaneous pedicle screw fixation. For instance, some surgeons believe that the multiple incisions required for the procedure can actually cause more tissue damage than would be generated by a more traditional surgical approach. In addition, researchers have not fully determined if percutaneous pedicle fixation provides some of the other benefits commonly associated with minimally-invasive procedures, including reduced blood loss during surgery, lower pain levels in the aftermath of surgery, shortened hospital stays and a quicker return to normal activity. Specific potential risks associated with pedicle screw fixation include breakage of the implanted screws or rods, infection and accidental damage to nerves near the site of the procedure. Generally speaking, the chances of experiencing any one of these complications are quite low.

References

Spine Health: Minimally Invasive Spine Fusion Systems (Pages 1-3)
Spine-Health: Pedicle Screws for Spine Fusion
“Neurosurgery”: Posterior Keyhole Corpectomy With Percutaneous Pedicle Screw Stabilization in the Surgical Management of Lumbar Burst Fractures
“Asian Journal of Neurosurgery”: Minimally Invasive Pedicle Screw Placement in a Case of L4 Fracture – Case Report With Review of Literature
“Chinese Journal of Traumatology”: Percutaneous Pedicle Screw Fixation Through the Pedicle of Fractured Vertebra in the Treatment of Type A Thoracolumbar Fractures…