Hybrid Technique for Cervical Pedicle Screw Placement. Issue 15 (1st August 2015)

• Record Type: Journal Article
• Authors: Kim, Moon-Kyu; Cho, Sung-Min; You, Seung-Hoon; Kim, In-Beom; Kwak, Dai-Soon
• Is Part Of: Spine. Volume 40:Issue 15(2015)
• Publication Date: 2015-08-01
• Subjects: Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000000986
• Languages: English
• ISSNs: 0362-2436

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Study Design.</title> <p>Cadaver study and clinical application; a pilot study.</p> </sec> <sec> <title>Objective.</title> <p>To minimize muscle dissection and enhance accuracy of cervical pedicle screw (CPS) placement by using a percutaneous cannula system.</p> </sec> <sec> <title>Summary of Background Data.</title> <p>Many studies have reported that the most frequent misplacement of CPSs is breach of the lateral wall; thus, an easy technique for securing medial convergence is required. We developed a percutaneous cannula system for this purpose and report the results of a cadaver study and its clinical application.</p> </sec> <sec> <title>Methods.</title> <p>A cadaver study was conducted to confirm the possibility of this percutaneous technique in 5 specimens (50 CPSs, C3–C7). Then, the technique was applied in 8 patients (40 CPSs, C3–C7). The surgical technique was a hybrid of miniopen surgery and the use of percutaneous cannula system under lateral fluoroscopic guidance. Entry holes were made in the open field and a cannula was used for tapping and insertion of CPSs. A stiff pedicle probe through the cannula was used to locate the pedicle in the lateral mass.</p> </sec> <sec> <title>Results.</title> <p>In the cadaver study, there were 12 (24%) misplacements among 50 CPSs used. The hybrid technique was applied clinically in 4 traumatic, 2 degenerative, and 2 failed back surgery lesions. Thirty CPSs were inserted using the percutaneous cannula system and 10 were inserted using a cannula as a retractor. Misplacement occurred in 6.7% (n = 2) and 20% (n = 2) pedicles, respectively, and there were no symptomatic complications (total incidence, 10%). An additional incision for the cannula system can be made for 2-level CPS insertions.</p> </sec> <sec> <title>Conclusion.</title> <p>Use of the percutaneous cannula system facilitated a secure convergence angle for CPS insertion without extending muscle dissection or shifting cervical alignment because of muscle retraction. Moreover, this system can be used for CPS insertion in bull-necked patients.</p> <p> <bold>Level of Evidence:</bold> 3</p> </sec> </abstract>