Placement of Guide-Wireless Sharp Percutaneous Pedicle Screws Utilizing Computed Tomography-Navigation and Sentinel Fluoroscopy: 2-Dimensional Operative Video

Authors

Nikolay L. Martirosyan, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.Follow
Joshua T. Wewel, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Juan S. Uribe, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.

Document Type

Article

Abstract

Many established techniques exist for minimally invasive pedicle screw placement. Nearly all techniques incorporate the use of a Kershner wire (K-wire) at various points in the work-flow. The use of a K-wire adds an additional step. If its position is lost, it requires repeating all previous steps, and placement is not without complication. The use of a guide-wireless sharp screws allows the surgeon to place a pedicle screw in 1 step with several fluid maneuvers.1 The patient underwent Institutional Review Board-approved consent for this study. Following traditional computed tomography-based navigation, a stab incision is made, followed by fascial dissection with monopolar cautery. The sharp screw is placed percutaneously at the facet-transverse process junction. The precise entry point is confirmed with navigation, followed by a sentinel anterior-posterior fluoroscopic image, verifying the accuracy of the navigation. The cortical bone is traversed by malleting the sharp tip through the cortex. When the cancellous bone is engaged, the screw is then advanced through the pedicle. This set of steps allows for safe, efficient placement of percutaneous pedicle screws without the need for a guidewire. Mal-placement regarding sharp pedicle screw insertion is similar to K-wire-dependent screw placement. Surgeons must be cognoscente of exceptionally sclerotic bone, which can prove difficult to cannulate. Conversely, osteoporotic bone that is liable to a cortical pedicle breach, transverse process fracture, and/or maltrajectory are all considerations when placing a K-wireless, sharp pedicle screw. Anterior-posterior fluoroscopy is utilized to confirm accuracy of image-guided navigation and mitigate malplacement of pedicle screws.

Medical Subject Headings

Fluoroscopy; Humans; Lumbar Vertebrae; Pedicle Screws; Spinal Fusion; Tomography, X-Ray Computed

Publication Date

8-1-2020

Publication Title

Operative neurosurgery (Hagerstown, Md.)

E-ISSN

2332-4260

Volume

19

Issue

2

First Page

E149

Last Page

E150

PubMed ID

31875896

Digital Object Identifier (DOI)

10.1093/ons/opz361

Recommended Citation

Martirosyan, Nikolay L.; Wewel, Joshua T.; and Uribe, Juan S., "Placement of Guide-Wireless Sharp Percutaneous Pedicle Screws Utilizing Computed Tomography-Navigation and Sentinel Fluoroscopy: 2-Dimensional Operative Video" (2020). Neurosurgery. 1713.
https://scholar.barrowneuro.org/neurosurgery/1713