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Abstract
Background
Minimally invasive spine surgery is a field of active and intense research. Image-guided percutaneous pedicle screw (PPS) placement is a valid alternative to the standard free-hand technique, thanks to technological advancements that provide potential improvement in accuracy and safety. Herein, we describe the clinical results of a surgical technique exploiting integration of neuronavigation and intraoperative neurophysiological monitoring (IONM) for minimally invasive PPS.
Materials and Methods
An intraoperative-computed tomography (CT)-based neuronavigation system was combined with IONM in a three-step technique for PPS. Clinical and radiological data were collected to evaluate the safety and efficacy of the procedure. The accuracy of PPS placement was classified according to the Gertzbein–Robbins scale.
Results
A total of 230 screws were placed in 49 patients. Only two screws were misplaced (0.8%); nevertheless, no clinical sign of radiculopathy was experienced by these patients. The majority of the screws (221, 96.1%) were classified as grade A according to Gertzbein–Robbins scale, seven screws were classified as grade B, one screw was classified as grade D, and one last screw was classified as grade E.
Conclusions
The proposed three-step, navigated, percutaneous procedure offers a safe and accurate alternative to traditional techniques for lumbar and sacral pedicle screw placement.
Level of Evidence Level 3.
Trial registration Not applicable.
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Details
1 Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Catholic University of Rome School of Medicine, Department of Neurosurgery, Rome, Italy (GRID:grid.411075.6) (ISNI:0000 0004 1760 4193); Mater Olbia Hospital, Department of Neurosurgery, Olbia, Italy (GRID:grid.513825.8) (ISNI:0000 0004 8503 7434)
2 Azienda Ospedaliera Universitaria “Luigi Vanvitelli”, Università Della Campania Luigi Vanvitelli, Department of Orthopaedics and Spine Surgery, Naples, Italy (GRID:grid.9841.4) (ISNI:0000 0001 2200 8888)
3 Mater Olbia Hospital, Department of Radiology, Olbia, Italy (GRID:grid.513825.8) (ISNI:0000 0004 8503 7434)
4 Mater Olbia Hospital, Department of Orthopaedics, Olbia, Italy (GRID:grid.513825.8) (ISNI:0000 0004 8503 7434)