Percutaneous pedicle screw fixation

Percutaneous pedicle screw fixation

Pedicle screw fixation is performed alone or in conjunction with spinal fusion to stabilize the spine. Pedicle screws provide stability by providing anchor points where metal rods are used to connect them. Pedicle screw fixation can be performed in a minimally invasive manner and is called percutaneous pedicle screw fixation.

What is percutaneous pedicle screw fixation?

Percutaneous pedicle fixation is a minimally invasive technique of inserting the pedicle screw. It does not require large traditional incisions as done in conventional open surgery, instead, screws and rods are inserted through multiple small incisions.

The muscle retraction in traditional open surgery is associated with significant morbidity leading to muscle denervation and atrophy, devascularization and increased bleeding, infections and postoperative pain in comparison with percutaneous pedicle screw fixation. Fusion and fixation are performed to relieve pain caused by painful abnormal motion in degenerative spinal conditions, to stabilize the spine in case of spinal fractures, to treat instability due to infection or tumour or to correct a spinal deformity.

Indication for percutaneous pedicle screw fixation

What are the symptoms?

Symptoms depend upon the underlying spinal condition and vary accordingly

How is it diagnosed?

What are the treatment options?

Percutaneous pedicle fixation is performed under general anaesthesia. First, tiny small incisions are made on the patient’s back under x-ray or navigation guidance. The pedicle is accessed through the pedicle cannula and guidewire is inserted through the cannula into the pedicle. The fascia and muscle must be dilated using dilators which allow for screw placement. The pedicle is prepared by placing the tap over the guidewire to accommodate the screw inside the vertebrae. The entire screw assembly is inserted over the guidewire and into the pedicle, after which guidewire is removed. All screws are inserted in this fashion, after inserting the required number of screws all screws are interconnected with a rod on either side. Rods are inserted into special slots at the screw heads and locked into place. The surgical instruments (screw extenders ) are then removed, and the incisions are closed with sutures.

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