Percutaneous Pedicle Screw Placement

Indications

• Lumbar fusion for symptomatic isthmic, degenerative, or traumatic spondylolisthesis; intractable discogenic back pain; or correction of symptomatic degenerative scoliosis.

• As an adjunct to direct lateral, transforaminal, posterior, or anterior interbody fusion.

• To supplement a posterolateral arthrodesis.

• As a posterior adjunct to an anterior decompression or stabilization procedure for any of the following conditions:

  • Trauma (e.g., burst fracture, Chance fracture).

  • Neoplasms (resulting in instability).

  • Infection (e.g., vertebral osteomyelitis, diskitis, spinal tuberculosis).

  • Degenerative conditions (anterior lumbar interbody fusion [controversial]).

Contraindications

• Severe osteoporosis.

• Inability to obtain adequate images even after modification of the contrast mode on fluoroscopy machine as a result of severe osteopenia or morbid obesity.

• Disease process (e.g., tumor, infection, fracture) involving or extending into pedicle of interest.

Planning and positioning

The following equipment is needed:

• Fluoroscopy (needs to be draped in such a fashion as to allow anteroposterior and lateral imaging without risk of operative field contamination).

• Radiolucent table and frame.

• Table that allows for free passage of the fluoroscopic C-arm gantry from anteroposterior to lateral position (i.e., Jackson table).

• Kirschner wire, Kirschner wire driver, and Jamshidi needle.

• Cannulated instruments for pedicle screw placement (various systems from different manufacturers can be used).