History of Retractor Technologies for Percutaneous Pedicle Screw Fixation Systems

The Mini-Open Wiltse Approach with Pedicle Screw Fixation Versus Percutaneous Pedicle Screw Fixation for Treatment of Neurologically Intact Thoracolumbar Fractures: A Systematic Review and Meta-Analysis

OBJECTIVE

The purpose of the present study was to compare the clinical outcomes and complications between the mini-open Wiltse approach with pedicle screw fixation (MWPSF) and percutaneous pedicle screw fixation (PPSF) in treating neurologically intact thoracolumbar fractures.

METHODS

We comprehensively searched PubMed, Web of Science, Embase, and the Cochrane Library and performed a systematic review and meta-analysis of all randomized controlled trials and retrospective comparative studies assessing these important indexes of the 2 methods using Review Manager, version 5.4. The clinical outcomes are presented as the risk difference for dichotomous outcomes and the mean difference for continuous outcomes with the 95% confidence intervals. Heterogeneity was assessed using the χ² test and I² statistics. The study was registered with PROSPERO (CRD 42021290078).

RESULTS

Two randomized controlled trials and six retrospective cohort studies were included in the present analysis. The percutaneous approach was associated with less intraoperative blood loss compared with the mini-open Wiltse approach. No significant differences were found in the total length of the incisions, hospitalization time, postoperative visual analog scale scores, postoperative Oswestry disability index, postoperative Cobb angle, postoperative Cobb angle correction, postoperative Cobb angle correction loss, accuracy rate of pedicle screw placement, and postoperative complications between MWPSF and PPSF. However, the incidence of facet joint violation was significantly higher in the PPSF group. In addition, MWPSF was associated with a shorter operative time, shorter intraoperative fluoroscopy time, lower hospitalization costs, better postoperative vertebral body angle and percentage of vertebral body height compared with PPSF.

CONCLUSIONS

Both MWPSF and PPSF are safe and effective treatments of neurologically intact thoracolumbar fractures. Nevertheless, our results have indicated that MWPSF might be the better choice, because it has a shorter learning curve and decreased facet joint violation, operative time, hospitalization costs, and radiation exposure. In addition, MWPSF was associated with better improvement of the postoperative vertebral body angle and percentage of vertebral body height.

Comparison of outcome between percutaneous pedicle screw fixation and the Mini-Open Wiltse Approach with pedicle screw fixation for neurologically intact thoracolumbar fractures: A retrospective study

BACKGROUND

The purpose of this study was to compare the outcome between percutaneous pedicle screw fixation (PPSF) and the mini-open Wiltse approach with pedicle screw fixation (MWPSF) for neurologically intact thoracolumbar fractures.

METHODS

From January 2017 to January 2019, ninety-four patients with neurologically intact thoracolumbar fractures were included in this study. In this retrospective study, forty-nine patients were operated with the PPSF and forty-five patients received MWPSF. The clinical information, surgery-related results and radiographic outcome were collected and compared between the two groups.

RESULTS

There was no significant difference between the two groups in total length of incisions, blood loss, post-operative hospitalization time, visual analog scale (VAS) score and Oswestry disability index (ODI) score. There was also no significant difference in the accuracy rate of pedicle screw placement between two groups; however, the facet joint violation (FJV) was significantly higher in the PPSF group. The atrophic area of multifidus muscle in the PPSF group is significantly larger than that in the MWPSF group and the operative time of MWPSF group was shorter than that in the PPSF group. Meanwhile, the PPSF group obtaining significantly more cumulative exposure to radiation (p < 0.001). The result of vertebral body angle (VBA), Cobb's angle and AVH rate in the MWPSF group were significantly better than those in the PPSF group at the last post-operative follow-up.

CONCLUSIONS

Both minimally invasive treatment techniques (PPSF and MWPSF) are safe and effective in treatment of neurologically intact thoracolumbar fractures. Nevertheless, our results indicate that MWPSF may be a better choice for neurologically intact thoracolumbar fractures, since it protects multifidus muscle, and decreases facet joint violation, operation time, as well as radiation exposure. In addition, MWPSF was associated with better reduction of kyphosis.

Assessment of the outcome of percutaneous pedicle screws in management of degenerative and traumatic dorsal and lumbar pathologies

Background

Percutaneous pedicle screw technique is relatively a recent technique that evolved the concept of posterior spinal instrumentation, utilizing familiar fluoroscopic landmarks to guide the procedure of screws insertion, which despite being technically demanding, it avoids the Musculo-ligamentous damage associated with the conventional posterior technique.

Aim of the work

This study aims to report our experience in managing traumatic and degenerative spine pathologies by the minimally invasive percutaneous technique and assessing its radiological and functional outcome.

Materials and methods

A prospective observational study that included the analysis of the functional, operative, biochemical, and radiological outcomes of 20 patients who underwent uniplanar fluoroscopic-guided dorsal and/or lumbar percutaneous pedicle screw fixation procedures with or without fusion using the sextant, longitude, and Spineart system and any reported complications between January 2018 and December 2019.

Results

The clinical and radiological analysis of 100 percutaneous pedicle screws in degenerative (n:11) and traumatic (n:9) dorsal and/or lumbar cases revealed that the biomechanical stabilizing characteristics are comparable to the conventional posterior approach with the added benefits of the paraspinal muscle-sparing. Satisfactory functional outcome represented in the improvement of the postoperative back pain visual analog score and Oswestry Disability Index Score with acceptable morbidity and complications rate was noticed.

Conclusions

Percutanous pedicle screw fixation is a landmark in the evolution of the minimally invasive spine surgery which can be a safe alternative to the conventional posterior muscle stripping technique with a comparable functional and radiological outcome and good biomechanical profile and an acceptable morbidity rate.

State of the union: a review of lumbar fusion indications and techniques for degenerative spine disease

Lumbar fusion is an accepted and effective technique for the treatment of lumbar degenerative disease. The practice has evolved continually since Albee and Hibbs independently reported the first cases in 1913, and advancements in both technique and patient selection continue through the present day. Clinical and radiological indications for surgery have been tested in trials, and other diagnostic modalities have developed and been studied. Fusion practices have also advanced; instrumentation, surgical approaches, biologics, and more recently, operative planning, have undergone stark changes at a seemingly increasing pace over the last decade. As the general population ages, treatment of degenerative lumbar disease will become a more prevalent-and costlier-issue for surgeons as well as the healthcare system overall. This review will cover the evolution of indications and techniques for fusion in degenerative lumbar disease, with emphasis on the evidence for current practices.